Surgical Tools to Include RFID

A better idea... by KingSkippus · 2006-07-19 06:17 · Score: 5, Funny

After closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside.

I have a better idea.

Before closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside.

The timing would be a little better, don't you think?

Re:A better idea... by gardyloo · 2006-07-19 06:19 · Score: 1

Why not just implant the receiver wand inside the patient? Then you can wave the scalpels over it. Or something.
Re:A better idea... by Anonymous Coward · 2006-07-19 06:23 · Score: 1, Interesting

This won't stop bits of surgical gauze being left beind. Can't chip them?
Re:A better idea... by 955301 · 2006-07-19 06:26 · Score: 2, Insightful

You'd think; however, the doctor needs tools to close you back up. If one of these tools is lost during the process and after the check, we're back to the same problem.

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You are checking your backups, aren't you?
Re:A better idea... by Duhavid · 2006-07-19 06:28 · Score: 1

Good point!

Perhaps a check at both points would be in order.

Cotton! Cotton!

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emt 377 emt 4
Re:A better idea... by Anonymous Coward · 2006-07-19 06:28 · Score: 0

Is this really that common an occurrence?
For the price we (or our insurance companies) pay for surgical procedures, you would expect a little more care on the part of the surgeons. Or is this just yet another technical solution to a minor and relatively rare problem that hostpital administrators are chomping at the bit to put in place so they can bump up the cost of *every* surgery?

In my mind this is about as useful as those "keyfinder" keychains from the early 80s. Remember those? you whistle or clap or whatever and the keychain beeps, thereby alerting you to the whereabouts of your precious keys.

Meh.
Re:A better idea... by 955301 · 2006-07-19 06:29 · Score: 1

The first check would be redundant then, and the process probably already includes a visual check.

--
You are checking your backups, aren't you?
Re:A better idea... by Anonymous Coward · 2006-07-19 06:30 · Score: 0

One word: Lawsuits. It stops being a minor problem when it costs you $20 mil every once in a while.
Re:A better idea... by Anonymous Coward · 2006-07-19 06:33 · Score: 0

No, it's not common, but everytime it happens, it costs the hospital's insurance millions of dollars, the doctor's insurance millions of dollars, and thats not counting the rest of the hassles of malpractice suits. I'm sure by doing this they'll save some on their respective malpractice insurance premiums, and like good little captialists they'll pass that savings right along by charging patients more.
Re:A better idea... by iezhy · 2006-07-19 06:36 · Score: 1

Before closing a patient, doctors would

Only before is not suficient, because during various stages of "closing the patient" process, additional surgical tools are often placed inside, especialy during more complex surgeries. Also, often you cannot remove all tools from open patient - e.g. the ones that hold veins and/or arteries closed
Re:A better idea... by Chris+Mattern · 2006-07-19 06:45 · Score: 1

The first check would not be redundant because it still provides a chance to find an instrument without having to reopen the patient. Of course you have a visual check, but it can miss things--obviously, since instruments are left in patients. However, it's possibly not practical because you'll pick up the RFID chips on the instruments used in closing. Maybe if you had an RFID scan that differentiated between instruments that stayed in while closing and those that don't...

CHris Mattern
Re:A better idea... by DannyO152 · 2006-07-19 06:51 · Score: 1

My thought exactly -- bet it would have made for a great patent for the portfolio.
Re:A better idea... by davidsyes · 2006-07-19 06:59 · Score: 1

Hopefully, the RFID is not cracked or hacked to become a controlling access point.

Imagine the rib-cage expander turning into a rib-cracker, or a circular saw becoming a hacker.

Hmmm, slash image word/word image: concept....

--
Previously: "Linux... Toward the Sunrise..." Now: "Linux... Toward the-- No, now, part of Every Sunrise"
Re:A better idea... by Burlap · 2006-07-19 07:02 · Score: 1

it's insanely rare... but like plane crashes, when they happen they are ALL OVER the news. that makes any procedure that will reduce it to zero a very good PR move on behalf of the hospital. This isnt so much a big deal here in the Great White North, but in the States where hospitals need to compete for patients for money, having such a system in place could make the difference in which hospital one goes to for surgery.
Re:A better idea... by Anonymous Coward · 2006-07-19 07:04 · Score: 0

In my mind this is about as useful as those "keyfinder" keychains from the early 80s. Remember those?

Yes. Mine fired off CS gas if I whistled "Rule Britannia", and exploded if I made a whistle of appreciation.
Re:A better idea... by Dun+Malg · 2006-07-19 07:09 · Score: 1

Maybe if you had an RFID scan that differentiated between instruments that stayed in while closing and those that don't...

I envision a fairly narrow reader pattern that only encloses the area being worked on. Combine this with an LCD "scoreboard" on the wall listing each and every tool that's still within the surgical area. The scanner runs continuously, like once a second, updating a "live" list on the LCD of all the tools a such still within the surgical area.

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If a job's not worth doing, it's not worth doing right.
Re:A better idea... by Jairun · 2006-07-19 07:12 · Score: 1

That's exactly the first thing that went through my head.
Re:A better idea... by hob42 · 2006-07-19 07:20 · Score: 1

Actually, two checks is the current standard for surgical counts - a first one before you close, and a final count after you close. It's better to find out before you close, but as he said, you might loose something during closing too.

The two issues I'd see with doing it *before* closing are:

1) all the other instruments are still near the patient, so the wand would need to have a pretty narrow field of reception, and

2) if it needs to be that close, the receiver itself will need to be a sterile instrument. Which means it must be more rugged, and therefore more costly.

Right now, if a surgical count isn't correct and the surgeon's looked and doesn't see it anywhere, but we have to suspect something was left inside, you finish closing the wound and have an portable xray done in the room. If they see something, they'll re-open and find it. Actually, the only reason they don't send the patient on and do the xray in the recovery unit later (since most the time missing things are on the floor, not in the patient), is if they find it when they're still inside the operating room, it doesn't count against them as an adverse event.
Re:A better idea... by lcsjk · 2006-07-19 07:24 · Score: 1

The RFID "tag" used for anti-theft in stores is nothing but a magnetostrictive strip. Such a device (but much smaller) could easily be embedded in a sponge or surgical pads. RFID chips that send back data are tiny, but the antenna used is larger. That determines the distance to the detector.
Some comments here talk about having the doctor take more time or do counts of sponges, instruments, etc,. After an hour or more operation where I am bleeding, I would prefer that the doctor hurry a little. I also understand how a small blood coverred pad that looks very much like tissue can easily be overlooked in the rush to complete a life-saving operation.
Re:A better idea... by timeOday · 2006-07-19 07:35 · Score: 1

Why use RFID at all, since it doesn't matter which particular surgical implement was left behind. How about a simple metal detector? It wouldn't catch some things, like sponges, but if they can put an RFID chip on there, why not a (cheaper) stainless steel bb embedded in the sponge?
Re:A better idea... by Facekhan · 2006-07-19 07:38 · Score: 1

Well I know that for surgical tape and gauz and stuff being left inside resulting in further surgery to remove it the usual settlement is 30-50k and it is usually not the doctor's fault since the nurses do the counts and they work for the hospital. Much of the malpractice cost for doctors is the result of lawyers shotgunning the lawsuit and suing everyone, the hospital, the surgeon, the anesthesiologist, the assisting surgeon, and their partners in their practice. My fathers a physician and he was recently named in a suit because another surgeon in his practice did the surgery and the hospital staff miscounted. It gets dismissed but he had to show up and take time from seeing patients and the insurance companies count it as a claim against the him because it costs money to send a lawyer to have his name dropped, which means his 15% discount for not having any claims in the last few years goes poof.

At least where I live, every surgery begins and ends with counts of all the tools and gauze and other materials being used, with usually more than one person confirming the count. Accidents do happen but it wasn't too long ago that there was basically no such thing as a malpractice lawsuit because people recognized that surgery was extremely risky and diagnostics is not an exact science. Of course now juries know that the money comes the insurance companies so they rationalize giving money to someone who suffered as a kind of charity that does not necesarily have to involve blaming the doctor, only feeling sorry for the patient, even if as in many cases the patient ignored medical advice.
Re:A better idea... by IAmTheDave · 2006-07-19 07:40 · Score: 1

Because of the very logic you impose. Besides, this also allows for:

1. Inventory before surgery, to be sure that all necessary parts for surgery are present
2. Inventory after surgery, to be sure that nothing is left in patient, and that all objects are accounted for
3. Generic inventory tracking of materials.
4. Alerts when inventory "walks" out of the hospital

RFID does have some potentially good uses. This is one of them - a brilliant one at that, because it saves lives - unlike putting them in IDs and passports, which has the potential to ruin lives.

--
Excuse my speling.
Making The Bar Project
Re:A better idea... by Duck+of+Death · 2006-07-19 07:41 · Score: 1

Funny, that was the first thing that went through my head, too. But I see from other comments that the closing process can involve tools inside the body.

Okay, then. How about we build the scanning equipment into the table? If nothing is detected, a telltale gives you a green light. If something is within a foot or so of the table (i.e. inside the patient) you get a red telltale. So surgery starts and the light goes red. When it's finished, you make sure the light is green.

Could multiple receivers built into the table allow for triangulation and tell the surgeon exactly where the signal is coming from?

I've seen some incredible "how'd they miss that" types of things that were left in by mistake.

DD

--
"Can I finish? Can I finish? ... Okay, I'm finished."
Re:A better idea... by andrewman327 · 2006-07-19 07:49 · Score: 1

I am the poster of the article. TFA says that there will be many safeguards taken to help prevent this kind of accident, but I wrote after because the testing they have done so far has been done after closing.

--
Information wants a fueled airplane waiting at the hangar and no one gets hurt.
Re:A better idea... by hob42 · 2006-07-19 07:53 · Score: 2, Interesting

This sounds like a fantastic idea, but it's likely it'd never be anything but fantasy.

My hospital just got around to putting computers in the operating rooms, and it'll be another couple years before we're acutally using them for charting and get rid of all the dead trees.

Something this flashy (read: expensive) for a (supposedly) rare occurance isn't gonna fly in today's hospital. Actually, I don't see anywhere but grant-funded specialty hospitals using RFID for counts. Now, I can see RFIDs in instruments being used to streamline the cleaning/processing/sterilization process - take a basin full of instruments, wave them one by one under the wand, and sort them into the proper sets. That could hold some promise and might get the process of getting it into the OR started.
Re:A better idea... by 3chuck3 · 2006-07-19 07:59 · Score: 1

I agree with Kingskippus, check for tools, BEFORE closeing the patient
Re:A better idea... by neersign · 2006-07-19 08:05 · Score: 1

or even better, how about the doctor opens his/her eyes before closing up the patient? No, that would be too easy, and there's no way to profit from it.
Re:A better idea... by Anne_Nonymous · 2006-07-19 08:23 · Score: 2, Funny

That would explain why WalMart keeps trying to charge me $59.95 for a hemostat every time I shop there.
Re:A better idea... by Lugae · 2006-07-19 08:40 · Score: 1

As I understand it, water, which the human body has a lot of, actually reduces the effectiveness of RFID. Wouldn't a closed patient essentially have a water shield around the RFID chip? Maybe not with an active tag and maybe these barriers have been overcome. Does anyone have an insight?
Re:A better idea... by hob42 · 2006-07-19 08:48 · Score: 1

Actually, inventory and billing are probably the best reasons for RFID in the OR. At least, the best way to pitch it and get it into the OR. Some hospitals have adopted barcoding for this, but RFID makes it even simpler. And believe me, simpler is better when it comes to my fellow well-educated but technologically-incompetent OR nurses.

Then, add in the additional uses for patient safety, and you've got a winner all-around. But hospitals aren't going to go for something this elaborate and expensive for patient safety alone.
Re:A better idea... by Slugster · 2006-07-19 09:08 · Score: 1

It is my understanding that OR consumables are left inside patients much more often than actual tools.
Consumables being things like packing, gauze, disposable clamps and the like that leads to later severe infections.

Many do a "tool count" before and after, but tracking how many rolls of gauze were opened (and where they all went) is rather tough to do under pressure.
~
Re:A better idea... by scottv67 · 2006-07-19 09:39 · Score: 2, Interesting

But hospitals aren't going to go for something this elaborate and expensive for patient safety alone.

Riiiight. What is cheaper? Implementing this system to make sure no surgical implements are left inside a patient or paying a MEGA lawsuit when something is left inside a patient (and the resulting negative publicity in the local press)?

Also, we (I work in healthcare) are seeing a bigger push for an asset tracking system that would be able to instantly display the location of certain "assets" that like to disappear in the hospital. Not stuff that is being stolen but items that are taken to a room and used and the next person who wants to use that device can not find it. An example would be: "Show me the current location of all of our infusion pumps."

The assets we want to track would have a small tag attached. A wireless (not necessarily 802.11) infrastructure would be able to use triangulation to determine the location of devices and display them on a floor plan. The bigger shops already have this. Implementing this service is on our To Do list.

Things that A) improve patient safety or B) save us money stand a very strong chance of getting implemented.
Re:A better idea... by kris_lang · 2006-07-19 10:03 · Score: 1

in an OR, they do have to count the pieces of gauze used as packing, and the number of sponges used, and even disposable clamps and the plastic clips used on scalp opening are most-definitely counted. That's part of the scrub-nurse's job and it's the surgeons job to make sure the count is correct before closing. Now they won't count how much methyl-matacrylate they used, or how much cyano-acrylate was used (superglue is often used, whether dictated or not...), but every item that can be counted IS counted.
Re:A better idea... by frdmfghtr · 2006-07-19 10:27 · Score: 1

Before closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside.

The timing would be a little better, don't you think?

Well, yes and no...

Yes in that it's easier to retrieve something before sewing up the incision (obviously).

No in that there are likely some implements that are in use while the patient is open, and are not removed until just before (or more likely during) closing the patient. Clamps and the like may be used to hold thigns together from the inside while being sewn from the outside, and then removed with only a stitch or three left. Mind you I'm nothing even resembling a surgeon, but it seems to make sense.

I'd think a more low-tech solution would already exist, such as a member of the surgical team that has ONE job and ONE job only--track the implements/materials used and inventory what goes in and out. It adds expense to the operation sure, but if it keeps things from being left in that require another expensive surgery to remove, then it's worth it.

--
Government's idea of a balanced budget: take money from the right pocket to balance...oh who am I kidding?
Re:A better idea... by hob42 · 2006-07-19 10:37 · Score: 1

I'm an RN in an OR myself. My cynicism is from experience.

What is cheaper?

Well, you'd think. The hospital budgets for lawsuits in advance, though, and our OR budget is already strained even before they shelled out several tens of thousands last week for two broken neuro microscopes.

Another part of the cost equation is the additional cost of RFID-embedded sponges and other disposables, which is a recurring cost beyond the wands and initial tagging of instruments. We already have an obscene amount of money going into the trashcan each case as it is.

More to the point, though, we already have systems - very cheap ones - to make surgical counts easier and safer. Someone mentioned the "shoe hanger" hanging counting bag for sorting out and visualizing sponges, of which our OR has exactly one, and is usually hidden in a storage room rather than used. Standards dictate at least two closing counts - three or more for abdominal cases - and yet most techs and nurses where I work just do one. And as a result we have people with retained sponges on operations where the RN wrote down "counts correct."

We already have systems for preventing medication errors on the surgical field - it's called a sterile marker and stickers. They come in every core supply pack we open. And we have techs who come in to relieve for lunch and find the last tech left a bunch of unlabeled syringes with clear liquid in them, a timebomb just waiting to go off.

I'm all for technology that will take some of the human error (whether caused by negligence, ignorance, complacency, or stress) out of the equation. For that matter, that wireless tracking system you point out would be great for inventory management, I'd love to have it. Our hospital already has two hospital-wide wireless networks - one for doctors' laptops, and one for the hospital's laptops on carts for nursing staff.

But anything with a bulletin point of "saves money" is gonna be implented well before an RFID surgical tracking system pitched explicitly on patient safety.
Re:A better idea... by hob42 · 2006-07-19 11:01 · Score: 1

I'm aware of that, since it's my job to do it. The part I see as a fantastic fantasy is the computerized system with an LCD on the wall keeping a running inventory of what's in the field. Rather like the Mass Gen's OR of the Future.

every item that can be counted IS counted.

I work with a surgeon who, when doing a laparoscopic case that might turn into an open case, asks new scrubs, "Did you count everything?"

Upon the tech saying yes, he'll start rattling off from a list he's made of things on the sterile field that aren't counted even when we do a full instrument count (he says it's more than 50 items long). Things like blue towels, the irrigation bowl, syringes, laparoscopic trocars, labels, the skin stapler, the little FRED jar (anti-fog solution), the disposable marker...
Re:A better idea... by scottv67 · 2006-07-19 11:26 · Score: 1

I'm an RN in an OR myself. My cynicism is from experience.

hob42, I'm one of the "IS guys" who comes to fix things (sometimes in the ORs) when they break. I've got a lot of respect for the work that you guys do.

Being in IS, I get to see the solutions that are on the radar and the stuff we are going to be working-on in the coming 12-24 months. I think the "asset location services" is going to be a big step for our organization.

Yes, the hospitals I support have wireless networks and we have laptops in use everywhere in the hospitals (even in the ORs themselves). I spent quite a few hours very early this morning sitting by myself in various ORs working on laptops that are used by surgical staff. As you know, the only time us "IS guys" can get into an OR to work on things like this is in the middle of the night.

I have watched surgical procedures through the glass (I was invited into an OR once while a surgery was in progress but I said 'I think I'll wait out here' :^) ) and all I've got to say is you guys have a really difficult job and you do really good work. I don't think that most people on the street appreciate what goes on in an OR. Seeing it on TV is just not the same as real life.

One item that I didn't see mentioned in this discussion is the factor of "time" when a patient in on the table. Some Slashdotters have asked "Duh, why don't you just stop and count everything? Car mechanics do it all the time." Well, there is a huge difference between a guy working under the hood of your car and a surgeon working on a patient. Time is a huge factor when someone's skin and tissue are open, when blood flow is stopped to a surgical site, etc.
Re:A better idea... by hob42 · 2006-07-19 12:28 · Score: 1

As an added benefit, the IS folks don't have to come out to my OR quite so much, since I can take care of a lot of stuff myself. Too bad they won't give me admin access. ;) (20+ years computer experience, and my previous career was tech support. Anyway.)

One item that I didn't see mentioned in this discussion is the factor of "time" when a patient in on the table.

True. Although, as we advance our surgical procedures to include more minimally-invasive operations (laparoscopic, microscopic, limited incision, etc) we actually increase patients' surgical times to reduce their recovery times. The benefits of the reduced tissue trauma and having the patient go straight home rather than to an inpatient unit for several days outweighs the downsides of longer surgical times. (It also costs the hospital less. The ever powerful dollar.)

In fact, perhaps the biggest "time" constraints we face is not the surgical time itself. First is our turnaround time - the time between the end of one case, and being ready for the next. A full instrument count on a large case could take 5-10 minutes - thus we don't count instruments except on open abdominal/chest cases. We face extreme pressure - to the point of being written up and disciplined - to make our turnaround times quick.

Second is the staff's time during a case. Counts aren't as simple as 'count at the beginning, count at the end' because very rarely can we anticipate exactly what will be needed in advance. We're always opening up new packages of gauze, new suture, new hemoclips, even opening up new single-wrapped instruments or entire instrument trays. It's very easy to forget to document one of those sutures on the count - or, even, write it down twice - and wind up with an incorrect count even when everything is actually there. Or to have a correct count when something is left inside. This is the human aspect of error that this RFID system could help with the most - you don't have to remember to do anything special to be able to check at the end of the case.

But I still think we could do just as much good to find ways to reduce the stress, time constraints, and complacency of OR staff, so that we all are doing our jobs right. It would relieve many other problems in the OR as well - don't even get me started on surgical site verification...
Re:A better idea... by teledyne · 2006-07-19 15:19 · Score: 2, Funny

Doctor: "Okay... time to check if we left any tools inside. I will need the RFID scanner."

Nurse: "Uh... I can't find it."

Doctor: "What? Oh shit..."
Re:A better idea... by Eivind · 2006-07-19 23:30 · Score: 1

You're correct. Accidents happen in all lines of work. The US system is silly. I've read that some kinds of doctors, such as those assisting by childbirth require "insurances" agains malpractice that can cost more than their salary.
In Norway theres instead two different sorts of settlements if you are mistreated.
In like literally 95% of the cases it'll be accidents of the type that can happen. Even if the doctor does his best according to his human limitations. Yes, afterwards we can see it was wrong. But it wasn't gross neglience or anything. It was a simple mistake. (just like the kernel just got a 'if (i = 0)' bug fixed to the correct 'if (i == 0)' The first is unquestionably wrong, but it's a type of bug that can happen even to a diligent coder.
In this case, the state picks up the tab. They have a special fund for such cases, and they'll pay for any direct losses you suffer as a consequence of the mistake. Cheaper than a insurance, for starters insurance-companies want to make a profit... Besides, in this case you don't get any extra cash for emotional suffering etc, only for your direct losses. Being alive *is* risky, sometimes you suffer trough no fault of your own. That's simply the price of being alive.
In a few cases though, its mistakes of a kind that should not be possible. That should really not happen if the doctor was doing his job properly. Not simply a mistake that could happen to anybody. But an error that could only happen if the doctor really failed to do what a doctor should do. In *this* case. (and this case only) the hospital and/or the doctor needs to pick up the tab. The doctor may also lose his licence as a doctor, it depends on the particulars.
Even in the latter cases, the amounts paid are much lower than those in the US. You do in this case get a cash-compensation for any additional suffering you've gone trough, but the amounts are much more conservative than in the US. My father lost articulation in one finger-joint due to a mistake made in supporting the finger when he broke it in a car-accidents a few years back. Technically that makes him 1% disabled, but it has no real influence on his job as a teacher, nor on his possibilities in his spare time. I think he got like $1000.
Re:A better idea... by andrewman327 · 2006-07-25 08:07 · Score: 1

There are some procedures where surgeons intentionally leave metal in the body. Also, the problem that TFA cites is size. Weaving ferrous metal into cloth and such seems like it could also be a size concern.

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Information wants a fueled airplane waiting at the hangar and no one gets hurt.
Re:A better idea... by Anonymous Coward · 2006-07-27 00:38 · Score: 0

RFID won't work on counting needles. They're too small to attach the RFIDs to, especially the 5-0 or 6-0 dermal closures that plastic types love.
Re:A better idea... by andrewman327 · 2006-07-27 00:53 · Score: 1

The next great invention: the RFID scanner scanner!

--
Information wants a fueled airplane waiting at the hangar and no one gets hurt.
Re:A better idea... by hob42 · 2006-07-27 16:17 · Score: 1

Or the 7-0's we use in the open hearts. I think we even have 12-0 suture in stock for eye cases.

Which means the most difficult things on the count to (1) make sure you've kept up to date, and (2) find when you come up short - those pesky needles that are probably on the floor, but since some brilliant manager installed black-and-white speckled rubber flooring you'll never find the thing - won't be any easier to count with RFID.

Not that you could even see one on an x-ray for an incorrect count, either. I have one MD brush that off, saying "something that small won't hurt anything." Great, just great.

Why not just count them? by Tweekster · 2006-07-19 06:17 · Score: 1

Or do what prisons do and have them outlined so they are put back in the spot they need to be in.

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The phrase "more better" is acceptable English. suck it grammar Nazis

Re:Why not just count them? by Wavicle · 2006-07-19 06:24 · Score: 1

I don't think doctors would want to work in the PMITA Surgical Suite.

--
Education is a better safeguard of liberty than a standing army.
Edward Everett (1794 - 1865)
Re:Why not just count them? by kfg · 2006-07-19 06:26 · Score: 1

How the hell do I sell chips that way? You haven't thought this thing all the way through.

KFG
Re:Why not just count them? by RobotRunAmok · 2006-07-19 06:26 · Score: 1

Because you can't manufacture and sell "common sense."

Seriously: take any application or tool that you manufacture or market, re-paint it (or re-style the GUI) in red, white, and shades of chrome, stick a friggin' caduceus in the upper right hand corner, then sell it into the Medical Industry as being "expressly configured for Doctors," jack up the price by a factor of SEVEN, and watch 'em fly outta your warehouse.
Re:Why not just count them? by Rob+T+Firefly · 2006-07-19 06:31 · Score: 1

You're trusting the counting ability of the same industry that spawned health insurance and HMOs, and tacks an extre $30 to your bill if you ask for a Tylenol?

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Slashdot Burying Stories About Slashdot Media Owned
Re:Why not just count them? by queequeg1 · 2006-07-19 06:42 · Score: 1

They do count them. Usually multiple times by different people. However, eventually someone will screw up (especially during a marathon operation lasting many hours).

One of the very first issues I had to deal with as a new attorney working in-house for a hospital were the hysterical parents of a patient who was going to have a "retained sponge" removed a few weeks after a C-section. Don't get me started on how screwed up that term is ("that crafty patient tried to steal a sponge by retaining it in her uterus while giving birth! The nerve of some people!"). If you've ever been through surgery before, you'll understand the importance of reducing even a very small chance of such screw ups. I would be totally pissed if I had to be cut open because someone screwed up an instrument count.
Re:Why not just count them? by Antique+Geekmeister · 2006-07-19 06:48 · Score: 2, Informative

Not a chance: you cannot mix the bloodied, used instruments with the sterile new ones on the shelf, they have to be discarded or autoclaved, and many of them are single use or packed in sterile containers which have no tool-secific shape.
Re:Why not just count them? by baadger · 2006-07-19 06:49 · Score: 1

...because after the scalpels been in your gut for the duration of the surgery I assume they dump them in a tin of some sort of strong disinfectant. You want them to neatly lay out there nice gorey used gut digging, spooning and screwing tools back on the tray?

If they did that, we'd end up with surgeons refusing to set the dinner table at home because it reminds them of work. Think of the consequences!
Re:Why not just count them? by mph · 2006-07-19 06:55 · Score: 1

If they did that, we'd end up with surgeons refusing to set the dinner table at home because it reminds them of work. Think of the consequences!
I was in the hospital over Thanksgiving one year, recovering from surgery. On Thanksgiving Day, my surgeon came in to check on her patients. I asked her if it was her job to carve the turkey for dinner. She said, "No, I'm too picky. I only use German instruments."
Re:Why not just count them? by Tweekster · 2006-07-19 07:02 · Score: 1

Um I meant on the table where they are alll set out for the doctor to use...

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The phrase "more better" is acceptable English. suck it grammar Nazis
Re:Why not just count them? by ptelligence · 2006-07-19 07:11 · Score: 1

Even with RFID, you're still gonna have to count your sponges and instruments. Even if every thing in the OR has an embedded RFID chip there's still gonna be a failure rate (low but not negligible). Nurses will still need to do multiple counts as who knows what may have made its way on to the tray in the heat of the moment. I'm not familiar with RFID chips, but can they withstand sterilization? Can you autoclave RFID chips? Is there any possibility of the chip falling off? It sounds like a great idea on the surface, but it is just another failsafe. The thing about medicine is that if such a product exists and it could reduce error and mortality, then there is a moral obligation to use it and bill for it. Thereby fattening the pockets of whoever makes it.
Re:Why not just count them? by Dare+nMc · 2006-07-19 08:12 · Score: 1

>Or do what prisons do and have them outlined so they are put back in the spot they need to be in.
a workable non tech solution to a non tech problem.
YOUR AT THE WRONG WEB SITE, this is slashdot.org nerds hang out here, we want to spend all day finding a tech solution to a perceived problem.
Re:Why not just count them? by scottv67 · 2006-07-19 09:59 · Score: 1

Or do what prisons do and have them outlined so they are put back in the spot they need to be in.

Believe it or not, ORs are not lined with massive sheets of pegboard that have the outlines of every single implement or consumable that may be used in an operation. The ORs I was in this morning (as well as other ORs on previous occassions) keep tools and supplies in rolling cabinets (think Craftsman tool chest) and wall-mounted cabinets with glass doors.

The tools and supplies are not always kept *in* the OR. Before the surgery begins, a number of people bring the items needed for that surgery into the room.

It's not as simple as looking at the empty spot on the pegboard hanging on the wall and saying "Gee, Wally, it looks like someone didn't return the adhesive mixing tool for knee replacement to its correct spot on the wall".
Re:Why not just count them? by spun · 2006-07-19 10:06 · Score: 1

Because you can't manufacture and sell "common sense."

I can. If you lack common sense, please send me $14.95 for a two week supply. You'll wonder how you ever got along without it!

--
- None can love freedom heartily, but good men; the rest love not freedom, but license. -- John Milton
Re:Why not just count them? by scottv67 · 2006-07-19 10:10 · Score: 1

This is going to draw some "Flamebait" moderations. Oh well...

You're trusting the counting ability of the same industry that spawned health insurance and HMOs, and tacks an extre $30 to your bill if you ask for a Tylenol?

Part of the reason that Tylenol costs you $30 is because there are a large number of patients who use a hospital's ER as their primary care office. They don't see a "family doctor" for small things like colds or backaches, but instead come to a hospital ER on a Saturday afternoon with non-urgent symptoms/issues. Those same people don't have insurance and don't pay for the services they use. Some of that cost is written-off by the hospital and some of that cost is passed-along to the people who *do* pay their bills.

Imagine going to your favorite fancy restaurant and finding out that a good percentage of the people who eat there don't pay for the food they consume. The restaurant management is going to increase the prices on the menu so the people who *do* pay their bills offset the dine-and-dash crowd.

AFTER they close the patient? by Hektor_Troy · 2006-07-19 06:18 · Score: 1

How about checking before you sew them up - you know - just in case you left something that you WON'T be using for that. Then you can do it agains afterwards of course.

--
We do not live in the 21st century. We live in the 20 second century.

Re:AFTER they close the patient? by robertjw · 2006-07-19 06:27 · Score: 1

Actually, how about both. Wouldn't want the surgeon losing his needle during the sewing process.

--
Find coupons in Greeley

What Happens... by dduardo · 2006-07-19 06:20 · Score: 5, Funny

What happens if they forget the reciever inside the person?

Doctor: Nurse, hand me the wand.
Nurse: Don't know where it is.
Doctor: Oh well, I'm sure I didn't leave anything inside.

Re:What Happens... by baadger · 2006-07-19 06:55 · Score: 1

What worries me is the guy who already has an RFID tag in his left hand.

Doctor: Oh shit!, we let something in his hand!
Assistant: But Doctor! We didn't operate on his left hand, this was only a vasectomy.
Doctor: ... This was a vasectomy?
Re:What Happens... by in2mind · 2006-07-19 08:24 · Score: 1

What happens if they forget the reciever inside the person?

They use the backup receiver to find the original receiver !

--
Wincopy
Re:What Happens... by JustKidding · 2006-07-19 19:11 · Score: 1

Doctor: Nurse, hand me the wand.
...
Doctor: Nurse?

Ahh... by phase_9 · 2006-07-19 06:20 · Score: 1

So THAT's where I left it!

Yea but... by gasmonso · 2006-07-19 06:21 · Score: 3, Informative

What if the hospital forgets to put the RFID chip in the instrument in the first place. It all comes down to accountability. Just count the damn tools before and after surgery. Seems simple to me. If there was a pliers before you started, then there should probably be one after you're done.

http://religiousfreaks.com/

Re:Yea but... by fm6 · 2006-07-19 06:23 · Score: 1

And of course it's totally impossible for the nurse who does the counting to miscount, especially after a 6-hour operation.
Re:Yea but... by Anonymous Coward · 2006-07-19 06:25 · Score: 0

If my surgery was any indicator, that's not really an option.

The surgical chamber was filled with trays of tools. What looked like literally a thousand tools, like watching an accident involving a truck transporting toolkits. Those tiny trays of tools in the movies? At least 20 of those, with big meaty power tools. (as an aside, God forbid they forget an impact wrench in someone)

Now granted, my surgery was pretty specialized (jaw surgery) but certainly, they use a lot of things in any given surgery.
Re:Yea but... by Anonymous Coward · 2006-07-19 06:38 · Score: 0

OK, seriously, you haven't had anything really earth-shattering to say, yet here you are posting as early in the thread as you can, just so you can get some .sig lovin' ... Just like the last bunch of threads I've seen you in.

It's fucking pathetic. You have a signature section in your user profile. You aren't using it because you're just whoring for clicks. I don't want to see signatures, I don't want every fucking post to be an ad for some shitty site that's probably just another fucking blog. That's why I don't have .sigs enabled. Until I come across shit posts like this.

There needs to be a moderation entry just for fucknuts like you. -1, Sigwhore. Get over yourself and your stupid website.

(I love anonymous posting..)
Re:Yea but... by DrLang21 · 2006-07-19 06:39 · Score: 1

For disposable items like sponges, the manufacturer would most likely be the one to put the RFID tags in them. I'm guessing the sponges spoken of in this artical are ones made by a local company here in Pittsburgh that recently started up to do this. Less disposable items such as clamps might be a more tricky situation. You would either need a tag that can be securely attached and easily disposed or you would need one that can survive steam sterilization.

--
I see the glass as full with a FoS of 2.
Re:Yea but... by Anonymous Coward · 2006-07-19 06:45 · Score: 0

Pliers? Ouch.
Re:Yea but... by StarvingSE · 2006-07-19 06:46 · Score: 1

Write the number down, have 2 nurses do a count and keep counting until the numbers match, there are a million ways to prevent this sort of human error. RFID: the solution to EVERYTHING!!!

--
I got nothin'
Re:Yea but... by 'nother+poster · 2006-07-19 06:47 · Score: 1

Yep. Also think about the dozens, if not hundreds of pads, sponges, gauze strips, and such that are used in an invasive surgery. Hell, if the surgery is one of those 8-12 hour marathons with 2-3 surgeons that require the use of, say, 14 pints of blood, there are possibly thousands of those items used to keep the view clear for the surgeons and nurses. Like someone can go "32. 33. 34. Ok, that's 368 gauze pads, 72 sponges, and 34 wads of gauze strips. That's everything. Lets close her up." Make it so the surgeons can go "Is that everything?" and a nurse waves the wand over the patient and says "No beep. We look good."
Re:Yea but... by DrLang21 · 2006-07-19 06:54 · Score: 1

They often do count the number of tools used before and after. Despite counting, tools still get accidentaly left inside patients. There are a lot of tools used in a surgery. Despite hearing horror stories, this is an extremely rare occurance. There are millions of surgeries performed each year, and the number of incidents of lost tools is on the order of 2000.

--
I see the glass as full with a FoS of 2.
Re:Yea but... by Lush_trashed · 2006-07-19 07:09 · Score: 1

But still, 2000 * $20m is a hell of a lot of $$ in law suites.
Re:Yea but... by Anonymous Coward · 2006-07-19 07:21 · Score: 0

If you read some of the article ... well, okay, neither did I. But I read about this yesterday. It turns out that hospitals DO count instruments. In a recent study they found that (1) this happens sometimes -- not often, but not terribly rare either, (2) in some cases there were not great procedures in place, like counting instruments, clearly designating a single person to be responsible for that job, etc. But in the vast majority of cases, the hosptial did have good procedures in place, the operating team did follow the procedure, and they counted the instruments before sewing the patient up, and then double checked after sewing them up and came up with the same number, the number they thought was the right number. But it wasn't. The reason was almost always due to sudden changes in the surgical plan -- i.e., they have the guy open, and are in the middle of surgery when run into a complication and need to change the plan. And many times this was very sudden emergency situations. So when suddenly something goes wrong and the surgeon needs a bunch of clamps, or sponges, or whatever, and the person keeping count sees 8 things go in, when really 9 of them did.

The real problem is obvious -- in even the best of situations, it is hard to keep track of stuff, especially lots of little, disposable, interchangeable things. And a surgery isn't the best of situations either.
Re:Yea but... by DrLang21 · 2006-07-19 07:34 · Score: 1

Yes it is. Which is why the RFID idea is still a really good one. I was merely trying to point out that people do count tools, and usually are successful in doing so. However, the problem still rears its ugly head from time to time, and it's a costly one.

--
I see the glass as full with a FoS of 2.
Re:Yea but... by Oxyrubber · 2006-07-19 08:28 · Score: 1

The fact is that they do count the sugical tools... but not after EVERY surgery. Hospitals set up their own policies regarding which surgeries require a tool count and how often (every surgery, every other sugery, etc.). I think it's a shame that this is even necessary. You would think that a surgeon would care enough about the patient to oversee the sutures... not rush off to his tee-time (the stereotype was used purely for effect).

I think it's funny that this story was published so soon after "when surgical tools go missing... 2" was shown on TDC/TLC (with a title and content much like the old Fox shows: "^When * go(es)? (missing|bad|rabid|etc)( [0-9]+)?$").

--
"If God had wanted us to vote, he would have given us candidates." - Jay Leno
Re:Yea but... by hob42 · 2006-07-19 08:41 · Score: 1

Like someone can go "32. 33. 34. Ok, that's 368 gauze pads, 72 sponges, and 34 wads of gauze strips. That's everything."

Well, that's what we do. Our open-heart cases routinely go over 100 suture needles, and our neuro cases have dozens of 1/2"x1/2" cotton sponges. We section off sponges in groups of five or ten, keep needles organized on a numbered magnet, and always have the tech and nurse count them *together* to help prevent mistakes.

And, we count them at least twice - once before closing and once after. At least that's what we're supposed to do - complacency and stress about time leads many of my coworkers to skip the final count, and I know at least one retained sponge case that resulted from this.

Make it so the surgeons can go "Is that everything?" [...]

They already take an x-ray if they have an emergency case and don't have time for a preoperative count, or the post-surgical counts are wrong. It'd probably be cheaper to roll each patient under a flouroscope on the way to the recovery room and glance at the screen to make sure you're good, than put wands in each room and RFIDs into all reusable and disposable instruments, sponges, needles (some of which are very tiny), blades, and other accessories, and hope one of them hasn't gone defective and stopped working during the case.

I'm still not convinced that this technology will do much for us above what we already have, in any form that an ordinary hospital will accept the cost of.
Re:Yea but... by fm6 · 2006-07-19 09:59 · Score: 1

You think hospitals have been ignoring this problem? Remember, every time it happens, they get sued for big bucks. Everything you can think of, you can bet they've tried.

Or maybe? by elzurawka · 2006-07-19 06:21 · Score: 2, Insightful

they should use this
if size matter, u cant been the size of Tomato Seed. All the tools could be put down on a sensor pad, and it could tell if everything has been returned, or have a running list of what is not on the pad ATM.

--
-EL

AFTER they close the patient?-for repairs. by Anonymous Coward · 2006-07-19 06:22 · Score: 1, Interesting

I'd like to know how they make that kind of mistake? It's not like there's a hell of a lot of room in there.

Anyway put the patient on a non-metallic table and run a metal detector over them.

Re:AFTER they close the patient?-for repairs. by gardyloo · 2006-07-19 06:25 · Score: 4, Funny

Anyway put the patient on a non-metallic table and run a metal detector over them.

Doctor: "Where's the table?"
Nurse: "It was right here under the patient, who seems to be lying on the floor... "
Doctor: "Oh... Where shall we have lunch?"
Re:AFTER they close the patient?-for repairs. by Pink+Tinkletini · 2006-07-19 06:26 · Score: 1

Pads, gauze, sponges and the like (the things most likely to be overlooked when closing up) aren't metallic.

--
And now, a PSA from David Lynch.
Re:AFTER they close the patient?-for repairs. by cayenne8 · 2006-07-19 06:27 · Score: 1

"Anyway put the patient on a non-metallic table and run a metal detector over them."
That wouldn't work in all cases...Dr's still put a good bit of metal in people on PURPOSE...pins for broken bones, plates in skulls....
There's a lot of people out there who could go through airport metal detectors naked and set them off like crazy, or can't go have an MRI due to internal metal content...

--
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
Re:AFTER they close the patient?-for repairs. by Mr.+Burrito · 2006-07-19 07:41 · Score: 1

Actually, that's not true. Every surgical tool is designed with a radioopaque (typically metallic) identifier. Sponges and pads, in particular, can be readily identified on a radiograph due to in-woven metallic wire. Some institutions implement standard post-surgical radiographs to excluded iatrogenic foreign bodies following surgery for this reason.
Re:AFTER they close the patient?-for repairs. by scottv67 · 2006-07-19 10:19 · Score: 1

Anyway put the patient on a non-metallic table and run a metal detector over them.

How would your plan work if someone had their knee replaced?
http://www.bonesmart.org/knee_replacement.php

Notice what the implants are made of? Metal.

Metal screws, plates and wires are used in surgeries. Using a simple metal detector just isn't going to work.
Re:AFTER they close the patient?-for repairs. by feed_me_cereal · 2006-07-19 10:37 · Score: 1

A metal detector is not suffiecient: not all tools are metal, and sometimes patients are fitted with something made of metal that is supposed to stay in their body.

Secondly, and more importantly: murphy's law applies in hospitals. There are *lots* of operations performed, so even if something is very unlikely to happen, over time it is nearly garanteed to happen to someone. That's why you need to set things up so that mistakes are nearly impossible.

--
"Question with boldness even the existence of a god." - Thomas Jefferson

Size matters by Anonymous Coward · 2006-07-19 06:23 · Score: 0

Given the recent article (and dupe) on the grain of rice memory that transmits... wirelessly, why not use that instead of shoehorning RFID into smaller and smaller sizes?

My Dog by lbmouse · 2006-07-19 06:24 · Score: 3, Funny

My dog has a very small RFID that I had the Vet intentional leave in him (name, address & phone number)... now my dog is suing me for violating his rights for privacy.

Re:My Dog by Anonymous Coward · 2006-07-19 06:34 · Score: 0

I should sue my dog. I have no privacy. She follows me everywhere I go and barks if I leave her somewhere.
Re:My Dog by 93,000 · 2006-07-19 06:54 · Score: 1

That's what happens when you go and treat him like a bitch.

--
Sweet informative mod.
Re:My Dog by CheddarHead · 2006-07-19 07:24 · Score: 1

My dog has a very small RFID that I had the Vet intentional leave in him (name, address & phone number)... now my dog is suing me for violating his rights for privacy.
Wow... that's ruff, but what can you do. It's a dog eat dog world out there.
Re:My Dog by biglig2 · 2006-07-19 11:46 · Score: 1

Doctor: My dog has a very small RFID...

Nurse: How does he smell?

Doctor: Oh crap, I'm in the wrong joke.

--
~~~~~ BigLig2? You mean there's another one of me?

How common is this problem... by dudeX · 2006-07-19 06:24 · Score: 4, Interesting

that we have to have use technology to prevent this from happening?
Why would surgeons (or assistants) think it's okay to leave a foreign object lying on top of an organ or tissue in the first place?! Also why is the surgeon in such a rush that s/he would be so sloppy?

Maybe this would be more appropiate for battlefield sitautions where things can get hairy, but then again, it's pretty rare to do open surgery in the battlefield!

Re:How common is this problem... by Anonymous Coward · 2006-07-19 06:31 · Score: 0

My Aunt had a large cloth the size of a very large napkin left inside after her abdominal surgery, the hospital quickly removed it and paid a large sum of money so it wouldnt hit the courts or worse the newspapers. So I guess it may happen more than we think.
Re:How common is this problem... by Duhavid · 2006-07-19 06:37 · Score: 1

With "health maintainance organizations" ( insurance companies )
in the driver's seat, doctors feel rushed to churn out as many
patients as possible. So, I suppose they ( insurance companies
and doctors ) see this as a way to reduce costs by reducing the
time the doc spends at the table.

--
emt 377 emt 4
Re:How common is this problem... by Mikeeee84 · 2006-07-19 06:44 · Score: 2, Informative

Around 1 in every 10,000 http://www.theregister.co.uk/2006/07/19/rfid_surge ry_debris/.
Re:How common is this problem... by Anonymous Coward · 2006-07-19 06:45 · Score: 1, Insightful

The most common foreign body left inside a body cavity is a sponge. They get tucked behind various organs/tissues to hold things in place, absorb blood/fluids, etc, and sometimes blend in with the surrounding tissues.

Counts *are* taken of equipment, sponges, etc, but... humans make mistakes. Considering the number of surgeries performed, it's actually pretty amazing how few items get left behind. The need for the technology, however, stems from how dire the consequences can be from a mistake.

If a mechanic leaves a washer inside an engine when reassembling it, it might do some damage, but most likely no one will die.
Re:How common is this problem... by LunaticTippy · 2006-07-19 06:49 · Score: 4, Interesting

It sounds as if you're unaware that US hospitals are in a state of absolute crisis. It isn't the surgeon's fault, and it isn't their choice. They are forced to work back-to-back 14 hour shifts. Emergency rooms are having their budgets slashed, having increased business from uninsured patients who can't afford routine care, and have trouble keeping staff from the abysmal working conditions and low pay.
Here is a good article on the subject. It claims the ER system is on the verge of collapse.
Hardly thinking it's okay to make mistakes, these poor people are in a constant state of sleep deprived chaotic panic.

--
Man, you really need that seminar!
Re:How common is this problem... by misterhypno · 2006-07-19 07:10 · Score: 2, Informative

Tell that to my late father-in-law, who died from EXACTLY this problem.

I'm sure that several members of his biological family would be happy to provide directions...

All snarkiness aside, this happens far more often than the general public would like to believe. ONCE is too often and, with some tools, like sponges, X-ray scans are unrevealing. In surgery, certain items are thrown away during the procedures and that's where problems can arise, especially during long and involved processes. This is why the "layout and count" solution proposed earlier by someone else won't work - some stuff gets thrown out and simply cannot BE counted!

When a surgeon has been on his or her feet for fifteen or twenty hours straight, doing highly technical work, demanding pinpoint precision, under life-or-death circumstances, it is relatively easy, at the end of the job, for the adrenaline to drop off and fatigue errors to happen, even in the best of circumstances and with the best in the business, which is exactly what happened in my father-in-law's case.

Lee Darrow, Chicago, IL
Re:How common is this problem... by lordsid · 2006-07-19 07:33 · Score: 1

You don't think an ER or even an operating rooms is hectic? Don't you ever watch TV?

--
IMAGE VERIFICATION IS EVIL!
Re:How common is this problem... by hob42 · 2006-07-19 08:10 · Score: 1

okay to leave a foreign object lying on top of an organ or tissue in the first place?

You mean like a clamp to stop bleeding, or a retractor to hold things in place, or sponges (cotton gauze) to keep tissue moist so it stays healthy? No, wouldn't want to use those during surgery, nope.

There are many reasons why sponges and instruments are placed *inside* an open surgical wound. And during, say, an abdominal procedure, it's easy for something that's gone inside to get covered and hidden by other organs. And the white cotton sponges obviously turn red when they're soaked with blood, which rather looks like everything else that's soaked with blood in the wound already.

Retained instruments isn't a symptom of HMOs or careless surgeons, it's a symptom of complacent OR staff.
Re:How common is this problem... by Anonymous Coward · 2006-07-19 08:19 · Score: 0

Hardly thinking it's okay to make mistakes, these poor people are in a constant state of sleep deprived chaotic panic.

That sounds like my office.
Re:How common is this problem... by JourneymanMereel · 2006-07-19 08:38 · Score: 1

Some instruments (such as a clamp) are designed for the express purpose of keeping them in the body during a surgery but not to stay there afterward.

--
Life has many choices. Eternity has two. What's yours?
Re:How common is this problem... by Joebert · 2006-07-19 09:02 · Score: 1

Also why is the surgeon in such a rush that s/he would be so sloppy?

It's not really much different than an Auto Mechanics job.
In both cases there's places that are safe to set tools with the hood up & the motor running, as well as places that will kill the engine if anything touches it.

A doctor may need to have somthing sitting right next to their hand so they can grab it after finishing with another tool without taking their hand off of somthing else.

Surgery is a race against the clock, a single second can mean alot of blood in some cases.

I'm no doctor, but I've got plenty of scars to backup my medical experience. ;)

--
Wanna fight ? Bend over, stick your head up your ass, and fight for air.
Re:How common is this problem... by Wudbaer · 2006-07-19 09:29 · Score: 4, Informative

You have to be aware that the inside of the human abdomen is a very crowded and puzzling place. Lots of nooks and crannies small items can slip into, also the whole thing is constantly on the move due to the contractions of the digestive organs, beathing and certainly due to the doctors operating and mocing things around. Add a certain amount of blood and bloody water (you flush surfaces both to keep them from drying out (bad for the tissue) and to keep a clear field of vision. Add several hours of operating time for large operations and there is a clear risk to lose things inside the patient. A professional operating team will take several security measures to keep this from happening (see my other post in this thread), but there still is a considerable riskm even without haste and neglect (yes, I am a MD by training).
Re:How common is this problem... by niko9 · 2006-07-19 10:37 · Score: 1

Why would surgeons (or assistants) think it's okay to leave a foreign object lying on top of an organ or tissue in the first place?

After reading your comment, I am 100% sure you have never seen the inside of anyone's chest cavity --or even have a basic first aid card for that matter--to understand the complexity of surgery and comprehend the problem. It's not a simple matter of all "foreign objects lying on top of an organ". Many surgeries run into multi-hour sessions where many surgical tools are used in a not so 2D human being. This is not counting the multitude of gauze, latex tubing, sutures, etc.

sterilization? by Yonder+Way · 2006-07-19 06:27 · Score: 4, Interesting

How rugged are RFID chips? How are they going to hold up to being heated in an autoclave for sterilization?

Re:sterilization? by ip_vjl · 2006-07-19 06:46 · Score: 1

They already have surgically implantable RFID chips. Vets implant them all the time. The same could be used for humans, but the reasons for doing so aren't as benign as with pets.

My concern would be (not yet having read the FA ... yeah, I know this is /.) how well the chips can be detected on/in metal equipment. The chips lose their ability to communicate in a short distance and metal seems to really cut down the ability to detect them at all.
Re:sterilization? by DrLang21 · 2006-07-19 07:01 · Score: 1

They don't use steam sterilization for sponges, they use EO gas. Plus, sponges are a one use item.

--
I see the glass as full with a FoS of 2.
Re:sterilization? by Big+Bob+the+Finder · 2006-07-19 09:36 · Score: 1

I don't know if ethylene oxide is used for all sponges- that's a bit pricey for disposable items like that. I know a number of items are sterilized with gamma radiation, which would flat out kill any electronics like RFID chips.
That would require chips being sterilized with ethylene oxide, after which they would be combined with gamma irradiated items- which in turn would have to be placed in sterile packaging. That compares with packing the disposables, nuking them, and shipping them out. Much higher risk of contamination (versus virtually assured sterility of unopened items), and much more expensive due to the combination step.
Re:sterilization? by Vellmont · 2006-07-19 09:49 · Score: 1

They already have surgically implantable RFID chips. Vets implant them all the time.

I know that you're right, so there must obviously be a way to sterilize the chips that doesn't de-activate them. The question I have is, is that process they use to sterilize these chips compatible with the methods used to sterlize surgical equipment? i.e. it could be that the chip sterlization method uses a chemical sterlization process that isn't normally used in hospitals (or some other non-standard sterilzation method). It may be impractical to use that same method in a hospital to sterilize the instruments.

--
AccountKiller
Re:sterilization? by DrLang21 · 2006-07-19 10:50 · Score: 1

A lot of disposables are sterilized with EO. Sterile bags for ultrasound probes for example. It's all part of why a little sponge seems to cost a hell of a lot more than it should.

--
I see the glass as full with a FoS of 2.

The OTHER Problem by mpapet · 2006-07-19 06:28 · Score: 1

they fail to mention is read range. As in, if the instrument is in too deep for the reader to power the module.

Most RFID just isn't right for this kind of application. Someone may figure it out though.

--
http://www.maxineudall.com/2010/02/should-economists-be-sued-for-malpractice.html

smaller size by PW2 · 2006-07-19 06:29 · Score: 1

If the scientists want to continue shrinking as the summary mentions, they should camp out on the space-station for a few years.

Can they take the heat? by the+darn · 2006-07-19 06:29 · Score: 2, Interesting

Don't they use an autoclave or some such to sterilize the instruments? Can the RFID chips take the heat, moisture and pressue invloved in that procedure?

--
Ceci n'est pas un post.

Re:Can they take the heat? by DrLang21 · 2006-07-19 07:03 · Score: 1

They use EO gas for things like sponges. Not hot at all.

--
I see the glass as full with a FoS of 2.

Probably not the real reason by foQ · 2006-07-19 06:32 · Score: 1

I suspect another reason to do this would be to prevent theft. Certain Cisco WAPs can pick up RFID so that you'd know how much of that overpriced equipment is walking out the door and can catch the hospital staff doing it. Unless, of course, they'd had an operation there before.

Re:Probably not the real reason by Antique+Geekmeister · 2006-07-19 06:55 · Score: 1

This has already been proposed for pharmaceuticals: Being able to track the time that certain bottles of drugs were handled is a big deal in accountability for some very expensive medications.

Do you not think it is strange... by LightningTH · 2006-07-19 06:32 · Score: 1

That you are paying a doctor quite a bit of money for an operation due to their expertice and yet they do not know how to remove their tools? Auto mechanics seem to know how to keep from leaving a wrench inside the engine that they had in pieces.

Maybe I would be better off going to the auto mechanic for major surgery.

Re:Do you not think it is strange... by kfg · 2006-07-19 06:38 · Score: 1

Auto mechanics seem to know how to keep from leaving a wrench inside the engine that they had in pieces.

No, actually, they don't.

To date I've never lost a tool under the hood of a bicycle though.

KFG
Re:Do you not think it is strange... by cooley · 2006-07-19 06:39 · Score: 1

Ah, but the difference is that an auto mechanic usually has to buy his or her own tools.

--
Just then the floating disembodied head of Colonel Sanders started yelling Everything You Know Is Wrong!-Weird Al
Re:Do you not think it is strange... by Chris_Jefferson · 2006-07-19 06:40 · Score: 1

How do you know auto mechanics don't leave tools inside? I'd imagine often it either wouldn't matter, or they would fall out in time. Even if someone did catch one, I doubt "Mechanic left rench in engine" would make the newspaper, whereas "Doctor leaves scapel in person" does everytime it happens.

--
Combination - fun iPhone puzzling
Re:Do you not think it is strange... by Anonymous Coward · 2006-07-19 06:43 · Score: 0

Doctor Vs. Mechanic
Larry was removing some engine valves from a car on the lift when he spotted
the famous heart surgeon Dr. Bill Johnson, who was standing off to the side,
waiting for the service manager. Larry, somewhat of a loud mouth, shouted
across the garage, "Hey Johnson...Is dat you? Come over here a minute."
The famous surgeon, a bit surprised, walked over to where Larry was working
on a car. Larry in a loud voice, all could hear, said argumentatively, "So
Mr. fancy doctor, look at this work. I also take valves out, grind 'em, put
in new parts, and when I finish this baby will purr like a kitten. So how
come you get the big bucks, when you and me are doing basically the same
work?"
Johnson, very embarrassed, walked away, and said softly, to Larry, "Try
doing your work with the engine running."
Re:Do you not think it is strange... by Anonymous Coward · 2006-07-19 06:44 · Score: 0

Yes, but mechanics either own their own tools, or are liable for replacing tools they lose inside engines.

Give the docs an incentive :)
Re:Do you not think it is strange... by Anonymous Coward · 2006-07-19 07:05 · Score: 0

I don't think I want them reusing sponges personally.
Re:Do you not think it is strange... by Dun+Malg · 2006-07-19 07:31 · Score: 4, Funny

Auto mechanics seem to know how to keep from leaving a wrench inside the engine that they had in pieces.
I have a really nice 3/8" drive Snap-On ratchet, extension, and 13mm socket that say otherwise.

--
If a job's not worth doing, it's not worth doing right.
Re:Do you not think it is strange... by ptbarnett · 2006-07-19 07:33 · Score: 1

How do you know auto mechanics don't leave tools inside?
Long ago, I found one sitting on top of the engine of my airplane.
I was selling the plane, and flew it to this particular place for an inspection. Typical pre-purchase inspection of an airplane includes a compression check of each cylinder in the engine. The wrench in question was one used to tighten the reinstalled spark plugs to a specific torque.
I called and asked how they wanted me to ship it back. They wouldn't provide me a UPS/FedEx account number, and I had since sold the plane (and it was too far to drive). I finally just decided to ship it back on my own. But, I had other things to do at the time (it's the reason I sold the plane), so I wasn't in a hurry to do it.
At one point, they were calling every day and getting pretty rude. I always thought it was strange, given the circumstances.

Okay. But... by Khaed · 2006-07-19 06:33 · Score: 3, Insightful

Just count the damn instruments.

Really. Car mechanics count screws.

I count the screws when putting a computer together or doing work in it. I keep up with where each one goes.

It didn't take me over eight years of college to figure this kind of thing out.

"Okay, doctor, we used five clamps, but we only have four. We must have left one..."

Duh? I mean, hello? You're a doctor. You're getting paid more than ninety percent of the population.

Learn to count.

Re:Okay. But... by truthsearch · 2006-07-19 06:37 · Score: 1

You can count instruments but a pile of bloody sponges is much harder to count. Besides, this solution is way geekier.

--
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Re:Okay. But... by elzurawka · 2006-07-19 06:43 · Score: 4, Insightful

If your in a emergency room, you might have hundreds of tools that you need quick access to. You dont have time to count, or probobly the mental dextarity to remember to count, the number of tools your using when your trying to save someones life.
You need to concentrate on what your doing, not on how many clamps you've used.

--
-EL
Re:Okay. But... by Phroggy · 2006-07-19 06:45 · Score: 0, Redundant

You can count instruments but a pile of bloody sponges is much harder to count.

But the sponges won't be getting RFID chips anyway, so you still have the same problem.

--
$x='S24;r)>63/* h@<5+oZ)32"5cz';$me='phroggy'x$];
$x=~y+ -xz+\0-Tx+;print$_^chop$me for split'',$x;
Re:Okay. But... by mph · 2006-07-19 06:49 · Score: 2, Informative

But the sponges won't be getting RFID chips anyway, so you still have the same problem.
Huh? TFA was about sponges with RFID chips!
Re:Okay. But... by EastCoastSurfer · 2006-07-19 06:51 · Score: 1

Bloody sponges shouldn't be hard either. They use things like the shoe holders that go on the back of doors. Each sponge gets it's own pocket and you count them that way. The few times I've observed surgeries everyone was meticulous about counting and recounting all the instruments and guass that were used.
Re:Okay. But... by Phroggy · 2006-07-19 07:01 · Score: 0, Offtopic

Ah, well, that's what I get for not RTFA - there was no mention of sponges in the summary, so I assumed they were only talking about tools. My bad.

--
$x='S24;r)>63/* h@<5+oZ)32"5cz';$me='phroggy'x$];
$x=~y+ -xz+\0-Tx+;print$_^chop$me for split'',$x;
Re:Okay. But... by gstoddart · 2006-07-19 07:06 · Score: 3, Insightful

Just count the damn instruments.

Really. Car mechanics count screws.

Well, I suspect in the case of surgeries, if something starts going wrong, they're probably more busy trying to keep you from dying than remembering if that was the 5th or 6th hemostat of the day.

When all goes perfectly normal, this might be easy. But when it starts going all to poo, I suspect that's a context in which careful counting can go by the wayside. Things probably get a little frantic when the patient is about to die.

(Admittedly, on a 'routine' procedure where everything goes as expected, I would think your solution would be effective and obvious. ;-)

Cheers

--
Lost at C:>. Found at C.
Re:Okay. But... by BalanceOfJudgement · 2006-07-19 07:22 · Score: 1

Here is the problem with "learn to count":

Nurse: 127, 128, 129...
Doctor: Nurse! The patient needs suction over here, now!
Nurse: Yes doctor. [begins suction]
Doctor: Thanks, that's good for now.
Nurse: 12.. uh.. what number was I on? Oh.. 129, 130...

When she should have started at 130.

Operating rooms are not an ideal environment for the attention to detail required to remember counts for potentially thousands of operating tools, not to mention sponges, etc. It usually is not the doctors counting the tools, it is the nurses, and there is NEVER just one nurse whose job it is to count - they're all moving around doing different things.

--

We are the fire that lights our world.. and we are the fire that consumes it.
Re:Okay. But... by Khaed · 2006-07-19 07:30 · Score: 1

Considering the side effects of leaving a clamp in a person: surgeons sure as hell better know how many clamps.

Generally, as far as my knowledge of this goes, the doctor isn't reaching out and grabbing the tools himself -- a nurse stands nearby. I'm not a surgeon. I'm just giving my opinion.

but I don't want to be operated on by someone who, with the aid of other surgeons and nurses, can't count.
Re:Okay. But... by Khaed · 2006-07-19 07:33 · Score: 1

I'm not saying "don't put RFID chips on them" or anything of the sort.

Just, y'know, surgeons should learn to count. Or at least the nurse handing them their instruments.
Re:Okay. But... by Khaed · 2006-07-19 07:36 · Score: 1

Simple solution.

A small device the nurse clicks a button on for each tool. Or have someone who *does* just count if it's that big of a surgey.
Re:Okay. But... by lazlo · 2006-07-19 07:37 · Score: 3, Insightful

a pile of bloody sponges is much harder to count

Maybe, but it's done. The last surgery I watched (my wife's C-section) they were extremely meticulous about sponges in versus sponges out. They double-checked the count of the number of packs-of-10 sponges in the room at the start, there was one person who it appeard had the sole duty of counting used sponges and putting them in little plastic strips with 10 sponge-sized pouches per strip. Then someone else double-checked that count. Then before they closed, they counted the number of unopened packs and added the number of plastic strips, and made sure it was the same as the number they started out with. It seemed like a very well-thought-out way of avoiding that exact problem.

Actually, as far as uses of RFID go, this seems like a fairly good one. The incremental cost of adding RFID to surgical instruments is trivial, you aren't working against a dedicated attacker trying to subvert your system, and although the number of instances of instruments left in patients is fairly low, this system, I would think, would probably cost-justify itself given the cost-per-incident-avoided.

--
Pound! Bang! Bin! Bash! is this a shell script or a Batman comic?
Re:Okay. But... by morie · 2006-07-19 07:56 · Score: 1

wow, you actually did get to read the article.

The /. effect must be diminishing and fading into the west...

--
Sig (appended to the end of comments I post, 54 chars)
Re:Okay. But... by BalanceOfJudgement · 2006-07-19 07:58 · Score: 1

A small device the nurse clicks a button on for each tool.
I saw a documentary once on this problem, and that was one of the solutions they tried. I don't recall how successful it was. They also did a trial of using RFID tagged items, and that proved pretty successful. Of course, it really needs to be trialed over the span of several dozen thousand surgeries to see how successful it'd be in the long run.

Or have someone who *does* just count if it's that big of a surgey.
In an age of shrinking personnel budgets, I'm not sure that's a possibility.

--

We are the fire that lights our world.. and we are the fire that consumes it.
Re:Okay. But... by Shadowlore · 2006-07-19 07:58 · Score: 2, Insightful

If your in a emergency room, you might have hundreds of tools that you need quick access to. You dont have time to count, or probobly the mental dextarity to remember to count, the number of tools your using when your trying to save someones life.
You need to concentrate on what your doing, not on how many clamps you've used.

That is why there are assistants! Seriously dude, you've got people, even in ER, who handle the tools and are not operating. Doctors don't just say "scalpel" and they magically appear in their hand. And they don't have to count either. A pair of trays. One with the tools laid out with a placement pattern below it, and the tools in their place, and an empty one next to it. When a tool is handed back you put it on the blank tray in it's place. No math involved, just your eyes. This type of procedure works well "on the battlefield", there is no reason not to work in a civilian ER.

Furthermore, it isn't that hard to look at the opening for shinys before closing it up. Between the assistants keeping track of tools and the doctor looking at his work to see if there are any tools left there, there should be no excuse for leaving things in. Period.

--
My Suburban burns less gasoline than your Prius.
Re:Okay. But... by MattHawk · 2006-07-19 08:00 · Score: 1

One of the big problems isn't the big metal tools that are easy to keep track of, but rather surgical sponges. They act as potential breading grounds for a post-operative infectiong, and they are astonishingly easy to miss - unlike the shiny metal tools, the sponges, when soaked with blood, look almost identical to body organs. Compound that with potentially dozens of such sponges being used in the course of an operation, multiple sponges used in one place getting tangled with each other, etc. and it makes it quite difficult to keep a count of them. Embedding an RFID tag in just the sponges would help most of the problems. They do count instruments, btw. There's a checklist of instruments that's reviewed before and after each operation. It just takes one slight miscount by a surgical assistant trying to count all the instruments and simultaneously help out with any of a myriad of other possible things the surgeon needs.
Re:Okay. But... by Anonymous Coward · 2006-07-19 08:04 · Score: 0

not everyone being operated on has their husband in the theatre watching
Re:Okay. But... by babyrat · 2006-07-19 08:30 · Score: 1

okay, so now it's time to close and there is a tool missing.

Where is it? In the patient, on the floor, stuck on some assistants sleeve, or pocket? Or behind the spleen, stuck in the intestines somewhere.

a quick swipe over the patient 'suggests' it is not there. It doesn't confirm it as there might be something faulty with the tag, but it means the doc can search elsewhere first, before digging around internal organs (which they can't like...)

Seriously dude, you think anything that could remotely help in some situations wouldn't be a good idea?

Go back to your little ideal world where everything works like it is supposed, and no-one makes mistakes and we'll stay here in the real world.
Re:Okay. But... by hob42 · 2006-07-19 09:15 · Score: 1

Now that's the way it's supposed to be done.

Wish I worked there, wherever that is.
Re:Okay. But... by nytes · 2006-07-19 10:00 · Score: 1

My wife went through surgery this last Christmas, while I waited with her parents in the waiting room.

When she came out the doctor told us that everything went fine but... They had to move her into XRay immediately because, after they had finished closing, the needle count was wrong. I thought my FIL was about to burst into tears.

It turned out to be a clerical error. Someone had written on a pad that they had 4 size A needles, and 2 size B needles, but when they looked at the packages they had, they counted 5 size A needles and 1 size B needle. They still had six needles, they just weren't the sizes they thought they should be. (Note: I don't know how they designate needle sizes, so this is a made-up example.)

An RFID system could help with this, in that they could have taken inventory before they started, and the computer could have flagged the discrepancy.

How they get an RFID tag into a needle, now that would seem to be a problem.

--
-- I have monkeys in my pants.
Re:Okay. But... by Vellmont · 2006-07-19 11:16 · Score: 1

Keeping a count of the instruments is already done, but it's not perfect. Why do you expect any system to be perfect? Any system has flaws in it, and the key to fixing these flaws is to have multiple redundancies so no single component (in this case people keeping counts) will cause a failure of the system.

Furthermore, it isn't that hard to look at the opening for shinys before closing it up.

Well, the article says that it's mostly sponges that get left in patients. I've also heard several stories reported in the news of sponges being left in patients, only to be discovered later when the patient complains of pain. Sponges as you may know tend to absorb blood, so they're difficult to see.

Between the assistants keeping track of tools and the doctor looking at his work to see if there are any tools left there, there should be no excuse for leaving things in. Period.

Well, maybe there's no "excuse", (that is, someone isn't directly responsible for the failure) but blaming people doesn't solve the continuing problem. There's always going to be people who miss-count, or miss a sponge no matter how much of a hard-ass you are. So you build those problems into your larger system and have independent redundant parts that catch failures.

--
AccountKiller
Re:Okay. But... by Shadowlore · 2006-07-19 13:28 · Score: 1

Well, the article says that it's mostly sponges that get left in patients. I've also heard several stories reported in the news of sponges being left in patients, only to be discovered later when the patient complains of pain. Sponges as you may know tend to absorb blood, so they're difficult to see.

Which is why counting *sponges* is crucial, as well as attaching sponges to handles or other means of making them more visible.

Well, maybe there's no "excuse", (that is, someone isn't directly responsible for the failure) but blaming people doesn't solve the continuing problem. There's always going to be people who miss-count, or miss a sponge no matter how much of a hard-ass you are. So you build those problems into your larger system and have independent redundant parts that catch failures.

And there will always be software/hardware failure in the detectors, failure to actually use the detector, interference from other devices, the RFID tag will fall out of the sponge prior to use, false positives will be created by the tag falling out in the body even without the spong leading to unnecessary re-opening of the boy, and so on. But the essential problem of failing to take the care and measures to actually verify you have removed everything you put in will not only not be addressed by RFID tagging them, but also exacerbated. "Ah hell why bother looking, the detector will catch it". Then we will be right back here lamenting why people don't use the detectors, or why they rely on them knowing they can and will fail, etc., and have spent all this money on "the system" only to get nowhere.

The problem is not a technological one, and can not be solved via technology. Doctors and OR assistants who do not follow a procedure to verify stuff is not left in before the "magic wand of foreign object detection" are not going to follow the magic wand procedure after it is put into place. Indeed, most surgeons may well take it as an insult to their ability and skill and avoid using them right out. The leaving of surgical tools in a patient is a failure of process. Either not having one or not following it. No amount of technology beyond a checklist and training in appropriate procedure will have as much effect.

We are talking about people who have the lives of families on the line here. If you can't be bothered to remember and follow the procedure, your ass needs to be somewhere else - regardless of how much you are paid.

How about instead doctors get publicly available ratings on the amount and/or frequency of foreign objects being left in patients; nurses and surgical assistants as well. The magic wand doesn't do anything other than hide failure to follow process, shoddy work, absentmindedness, etc..

If you think technology can prevent doctors from doing this (leaving objects in patients), just look at how much bad spelling is set loose upon the world in documents and email in spite of spell-checkers. Just as "autocorrect" does nothing to prevent or curtail the root of the problem (user doesn't know the spelling/capitalization/etc.), neither will RFID tags in surgical tools. There are countless more cases where this scenario shows itself.

TO quote one case:

In one of my cases, a huge lap pad (a type of surgical sponge) measuring over 10 inches in length was accidentally left behind in my client's abdomen by the surgical team
A sponge larger than the doctor's hand he left behind. That is as inept as a grade school teaching writing "great job!" on the top of a math assignment that had a mere 3 out of 11 correct. I've also seen the x-rays and reports of 13 inch long retractors, 7-12 inch long clamps, and pieces of equipment that got broke off all being left behind.

From 1985 to 1998, the incidence of objects being left within surgical patients has occurred at a steady rate of more than 40 per year. Specifically, 601 such cases have involved hospitals, surgical clinics, and physicians i

--
My Suburban burns less gasoline than your Prius.
Re:Okay. But... by Vellmont · 2006-07-19 14:53 · Score: 1

You're not looking at this problem from a realistic perspective. Your solution seems to be "DON'T MAKE ERRORS!!". Well, any system (including even machines) is going to have errors in it that cause problems. Simply wishing that people didn't make errors doesn't change anything. Could different hospitals have a better counting scheme that made sure that the count was accurate? I'm sure they could, but that doesn't diminish the need for something like this RFID system.

You try to minimize errors in each component, and have backup components that will work when the primary system fails. Of course the RFID isn't a perfect solution. It's not going to catch every single problem, but as long as it fails independently with the normal counting system, it's done its job. There is no perfect solution. I suggest if you're looking for life to be perfect and never to experience any failures, you're looking at a very depressing future.

--
AccountKiller
Re:Okay. But... by kent_eh · 2006-07-20 01:57 · Score: 1

Just count the damn instruments.
That's what happens now, at least in the Canadian hospital where my wife had her c-section. During the procedure I saw one of the nurses in the operating room do a full inventory of instruments, sponges, and everything else that the surgeon had access to at least 4 times. (Maybe more, I was a little pre-ocupied at the time.)
And she stopped the surgeon and assistant once to ask which tools they had in their hands at the moment when she had a discrepancy in the count.

--

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"I can't complain, but sometimes still do..." Joe Walsh

So that's why... by digitaldc · 2006-07-19 06:38 · Score: 4, Funny

...I keep getting an unexplained $248.99 charge at the Target express line!

--
He who knows best knows how little he knows. - Thomas Jefferson

Re:So that's why... by powerlord · 2006-07-19 08:09 · Score: 2, Funny

...I keep getting an unexplained $248.99 charge at the Target express line!
... and you wondered why it kept showing up on the receipt as "SURGCL STEEL CHST SPRDR"

--
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Re:So that's why... by mbstone · 2006-07-19 15:19 · Score: 1

...I was arrested trying to exit a Wal-Mart and found I had both false imprisonment and malpractice lawsuits!

Common occurrence? by LunaticTippy · 2006-07-19 06:39 · Score: 2, Insightful

I'd say it's fairly common. Common enough that I personally know 3 people who've had things left inside them.

Expect it to become more and more common as surgeons become even more painfully overworked. It's not their fault. I blame a bizarre system of high spiralling costs combined with drastic costcutting.

This may be an effective solution for leaving surgical tools behind, but that is treating a symptom instead of the root cause. Which is typical of US healthcare.

--
Man, you really need that seminar!

Re:Common occurrence? by Dun+Malg · 2006-07-19 07:21 · Score: 3, Informative

Expect it to become more and more common as surgeons become even more painfully overworked. It's not their fault. I blame a bizarre system of high spiralling costs combined with drastic costcutting.
Don't forget the AMA, which tells medical schools how many doctors they're allowed to graduate every year. They've been artificially limiting the doctor supply from the beginning. If too many doctors are allowed, it might end up like (say) Austria, where you can wander in to a doctor's office and have a mole removed without an appointment for forty bucks. Heaven forbid the "noble" profession of doctoring should be reduced to what it really is, that of a "biologcal mechanic". It's the same moronic mindset that continues to allow the practice of hazing in the form of "residency".

--
If a job's not worth doing, it's not worth doing right.
Re:Common occurrence? by keepingmyheaddown · 2006-07-19 07:21 · Score: 1

Wow, you personally know 3 people who had instruments left in them? That's quite a statistical anomaly. Where are your friends getting their surgeries, AAMCO?
Re:Common occurrence? by timeOday · 2006-07-19 07:41 · Score: 1

Do you have a cite? I've always suspected doctors collectively manipulate the market this way, but I couldn't find a credible source, nor an explanation of how it works. Is it just as simple as doctors dictating how many new doctors will be trained? How hard is it for doctors trained elsewhere to transfer? I think it's time for a medical H1B visa program.
Re:Common occurrence? by Anonymous Coward · 2006-07-19 08:25 · Score: 0

How hard is it for doctors trained elsewhere to transfer?
A woman I know who was a paediatric nurse in Germany is not working in that profession because the re-certification costs are prohibitive. This is Germany mind you, which has a western medical tradition at least as old as that of the USA, older if you include leading edge research capabilities.
Re:Common occurrence? by Anonymous Coward · 2006-07-19 08:46 · Score: 0

Um, I think it's quite obvious that Germany has a medical tradition older than the US (not _at least_ as old). The tradition started before the US even existed! But then again Germany as a unified country hasn't existed for that long either...
Re:Common occurrence? by Mr.+Burrito · 2006-07-19 08:51 · Score: 5, Insightful

There is actually a lot that goes into becoming a competent physician. You may want your doctor to remove a mole now, but if that was all your doctor could do you might feel shortchanged when you needed someone to be able to manage your barely compensated congestive heart failure, set up your mechanical ventilator when you develop ARDS after a devastating car accident, or coax your premature infant through the first months of life.

In some ways a physician is a "biological mechanic" (I suppose). But a physican in the US accepts at minimum 11 years of school and post-graduate medical training after high school (in my own experience, 16 years), and typically accrues between $150-400k in debt during this time. But more important than the enduring agony of never-ending school (much of which is also physically demanding), they also accept the emotional responsibility for others' lives.

This responsibilty is drilled into us from the time we enter medical school and continues throughout training. Medicine is a noble profession and it has to be, because there is a lot at stake. We enter into a legally binding contract with every patient we talk to, touch, or are curb-sided about by a colleague, to provide medical care that is "standard of care". This is a lot of responsibility and it is a heavy burden.

When patients die in our care, even if it is not "our fault", it is very difficult. Until you have had to personally sign the order: "1)comfort care only -- start morphine drip, 2) extubate" for a critically ill patient who has reached the point of medical futility despite your 2 weeks of effort, and then hold their hand as you let them die, you will not understand this kind of contract. But just about every physician has had to do this, probably within the first few months of internship.

With regard to residency being a hazing experience -- in some ways this is true. However, there are just a certain number of situations and disease states that you have to encounter in training and life is only so long. If you cut the hours in half, you really would need to be in residency twice as long to be competent on your own. Then I guess we would really be in a bind as far as physician supply. The AMA has a difficult job enough as it is, balancing physician supply with demand and making sure that training programs meet minimum standards to ensure adequate training.

The economics of health care are admittedly complex. However, the $40 you spend in Austria is in fact heavily subsidized by taxes. Somebody has to pay the transcripionist, the nurses, the medical assistants, the overhead associated with the clinic physical plant, among numerous other things. Then some portion maybe ought to go to the physician who is actually seeing the patient. In the US, somewhat less than 15% of health care costs represent physician reimbursement. Apply this to your $40 tab in Austria and use your analytical skills to show me how this makes financial sense.
Re:Common occurrence? by dlt074 · 2006-07-19 09:04 · Score: 1

actually, i walked into my doctors office and paid $40.00 to have a mole removed it was even on a saturday. that's what happens when you pay cash and they don't have to deal with insurance companies.

it's one of the best programs around. http://www.simplecare.com/
Re:Common occurrence? by LunaticTippy · 2006-07-19 09:41 · Score: 1

To be accurate, 3 people had something left in them. None of them were instruments. Two pieces of gauze and a sponge. The sponge was at the Mayo clinic in Arizona, hardly a low-rent shop. One of the gauze pieces was found in a subsequent surgery and was not causing trouble, the other was found when healing was going poorly and they went back in.
My grandpa had over 100 surgeries in his life (worked in a smelter) and my family talks way too much about medical problems. I'm glad I'm adopted.
In any case, there are thousands of instruments left inside patients every year. Family/friends + FOAF + FOAFOAF would yield several cases for most people.

--
Man, you really need that seminar!
Re:Common occurrence? by Anonymous Coward · 2006-07-19 09:48 · Score: 1, Funny

Common enough that I personally know 3 people who've had things left inside them.

Are you counting your sister as one of the three? I left something inside her last night...
Re:Common occurrence? by keepingmyheaddown · 2006-07-19 10:53 · Score: 1

100 surgeries, whoa, that's a statistical anomaly right there :-0

Last study I recall the US annual total was 2,000 incidents total, something like 30% of which were instruments. So if the population is 300,000,000 that's 1 person in 150,000 gets a little gift each year. You must have a lot of friends.
Re:Common occurrence? by Dun+Malg · 2006-07-19 11:35 · Score: 1

There is actually a lot that goes into becoming a competent physician. You may want your doctor to remove a mole now, but if that was all your doctor could do you might feel shortchanged when you needed someone to be able to manage your barely compensated congestive heart failure, set up your mechanical ventilator when you develop ARDS after a devastating car accident, or coax your premature infant through the first months of life.
See, this is exactly the problem. Not even half of "doctoring" is critical care stuff. Most of it is routine care. By setting an unnecessarily high bar to entry on such a wide-ranging profession, the supply is limited. Why the hell would you go to a dermatologist to manage congestive heart failure? Or to install a ventilator after an accident? That's as dumb as taking your car to an upholstery shop to have the transmission rebuilt. On the flip side, what kind of idiocy does it take to require an prospective upholsterer to learn basic transmission repair before he can go stuff new foam into car seats? No sense at all, but by being a private guild that's been permitted to control medical licensing in this country, the AMA has done exactly that.

In some ways a physician is a "biological mechanic" (I suppose). But a physican in the US accepts at minimum 11 years of school and post-graduate medical training after high school (in my own experience, 16 years), and typically accrues between $150-400k in debt during this time.
So you're saying that because the AMA requires such a ridiculous degree of schooling just to become the lowest possible level of doctor that students accrue huge debts that this justifies the supply being low and the wages being high? I wish I could demand higher pay simply because my education was expensive and unnecessarily difficult.

But more important than the enduring agony of never-ending school (much of which is also physically demanding), they also accept the emotional responsibility for others' lives.
So what? There doesn't seem to be any limit on the number of people willing to take on that burden. There only seems to be a limit on the number of people who can fight their way through the expense and difficulty of a decade-plus of training. Why do all doctors have to go through that? Do you need 16 years training to remove a mole?

This responsibilty is drilled into us from the time we enter medical school and continues throughout training. Medicine is a noble profession and it has to be, because there is a lot at stake. We enter into a legally binding contract with every patient we talk to, touch, or are curb-sided about by a colleague, to provide medical care that is "standard of care". This is a lot of responsibility and it is a heavy burden.
Further evidence of the "every doctor a superman" philosophy so prevalent in the US. You think the medical profession is the only one with a strict code of conduct?

With regard to residency being a hazing experience -- in some ways this is true. However, there are just a certain number of situations and disease states that you have to encounter in training and life is only so long. If you cut the hours in half, you really would need to be in residency twice as long to be competent on your own.
Competent to remove a mole? Why does every doctor need to be a so heavily trained? Why are they intent on accepting nothing less than a general master for any and all positions of responsibility in the medical profession?

Then I guess we would really be in a bind as far as physician supply. The AMA has a difficult job enough as it is, balancing physician supply with demand and making sure that training programs meet minimum standards to ensure adequate training.
But does no one question the necessity of such minimum standards? Seriously, they're the equivalent if requi

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If a job's not worth doing, it's not worth doing right.
Re:Common occurrence? by Dun+Malg · 2006-07-19 12:36 · Score: 1

Do you have a cite? I've always suspected doctors collectively manipulate the market this way, but I couldn't find a credible source, nor an explanation of how it works. Is it just as simple as doctors dictating how many new doctors will be trained?
Well, there was a class action lawsuit that alleged exactly that a while back, but it was dismissed. I think looking for overt manipulation like that is barking up the wrong tree. The problem is much more basic. The AMA is a private professional guild that has no public oversight. Despite this, they have become the governing body deciding who does and does not get a license to practice medicine in thius country. As such, they get to decide what is required of a prospective doctor before they are granted a license. Among other things, they decide what schools are acceptable and how long an apprenticeship (called "residency") one must endure to qualify. The problem is that about a hundred years ago the AMA got it into its collective head that doctors should only be some sort of elite, upper class. To further that notion they required more and more arguably unnecessary schooling and experience before awarding a license. They rationalize it as quality control by claiming that every doctor should be the "best possible", but that's ridiculous. Sure, it'd be great if every doctor could look at a list of symptoms and say "AHA! He is suffering sleeping sickness from the bite of a tsetse fly!", but does it really make sense to expect that level of skill from a guy who only intends to remove warts? Is there no room in the US for a class of medical practitioner somewhere below the current minimum? They have 'em in other countries.

How hard is it for doctors trained elsewhere to transfer? I think it's time for a medical H1B visa program.
The AMA has always (successfully) argued for strict limits on the imigration of foreign doctors, explicitly arguing that they would depress wages. Scum.

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If a job's not worth doing, it's not worth doing right.
Re:Common occurrence? by Mr.+Burrito · 2006-07-19 14:11 · Score: 2, Insightful

Your equating the practice of medicine to installing upholstery and transmission repair is a little humorous. I guess you would want the upholsterer to know about transmission repair if they were connected by thick blood vessels that were bleeding like stink and the car was about to die. An upholsterer can go take a bathroom break and catch Oprah in the middle of a job. I really would have liked to do that on numerous occasions in the OR. You say that the critical stuff doesn't happen very much, but 50% of my medical school class specialized in fields other than primary care, and even some fraction of the primary care folks are hospitalists and they deal with very sick patients on a daily basis. I actually know very few people in my class who don't deal with very sick people on a daily basis. Besides that, knowing what is critical and what isn't isn't easy, and when doctors screw that up is when they make the evening news. But I will try to explain this difficult topic.
For starters, dermatologists are and really need to be experts of the skin system. The skin is actually a fantastically complex organ that is essential for survival. There are all kinds of primary skin disorders as well as all kinds of cutaneous manifestations of systemic diseases that dermatologists must recognize, understand, and know how to treat. So they need to know a lot about all these other systems and communicate effectively to the doctors that treat those systems, too. They perform a lot of surgery and prescribe a lot of medications, and they need to understand all sorts of medical issues that might be contraindications to surgery or medication, including congesive heart failure. They need to understand and be able to treat or at least provide initial treatment of a number of possible complications. They need to communicate effectively with the pathologist, with the internist (who may further coordinate care), or the general surgeon, who may be called upon to perform more extensive surgery. Dermatologists may be involved in continuing care of patients with quite complex medical histories. Dermatologists typically do a medicine internship before their residency training. This can be very demanding, but it is absolutely necessary.
But maybe you went to family practice doctor first. Believe it or not, a family doctor needs their medical school and residency to: 1) know that it probably is a mole and not a melanoma, 2) know what medications to use for local anesthesia, their contraindications, and how much to use, 3) what the best resection method is to preserve a good cosmetic outcome, 4) how to suture it up without it popping open and increasing the risk of infection or a bad cosmetic outcome, 5) how to package the skin sample so that the pathologist can examine it effectively, 6) read and understand the pathologist's report, and 7) know what to do next if the mole actually isn't a mole but a melanoma. These are just the basics, though, because there are whole books written about each step. After the mole is removed, you might want to talk to your FP about some palpitations you've been having, and he or she needs to know all about the heart -- what is worriesome, what is not, how to read an EKG, etc. Or you might want to ask about your back pain, and he or she needs to know what the worrisome signs are (because there are actually a lot of things that can cause back pain that you really need to rule out even though common things are common). The FP is also looking out for your best interests and keeping track of when you need a mammogram or a colonoscopy, and they need to know all about breast and colon cancer. The list of things they need to know is very long. What specifically would you have them not know about?
The AMA has a pretty powerful say, but a lot of physicians are not AMA members. The various medical colleges keep a very close eye on the minimum requirements for training for minimum competence in the various specialties. Medical school really is the minimum level of training for a doct
Re:Common occurrence? by syousef · 2006-07-19 18:59 · Score: 1

The medical establishment is broken for the same reason that the patent, copyright and general legal systems are broken: It's steeped in hundreds of years of tradition and evolved in an environment that has changed dramatically in the last hundred years. Yes the surgeons have kept up with the technology but the culture of the medical establishment is absolutely and unforgivably antiquated.

First of all long shifts are counter-productive. I don't want a doctor, no matter how good, looking at me at the end of a 14 hour (or LONGER) shift.

Secondly, societies need to decide if they want to take care of the ill or not. It's costly and the user pays system is unworkable here because the sickest people are the least likely to be able to afford care. This is what we should be paying taxes for.

Thirdly while willing to adopt tools and medical gadgetry the medical industry has been unwilling to adopt medical diagnosis via computer even as a backup to looking through books. Even the legal profession is ahead of the medical establishment when it comes to this as you can get compurerised searchable caselaw. Even the best doctor hasn't seen every medical condition and won't have heard of the rarer ones so I'd like to see a standard system where a doctor could put in symptoms and look up a database of matching possible illnesses and other symptoms to check for. I would not want this system to replace the doctor's judgement but I do want it to be an integral part of the process.

Forthly, the idea of longer internships and learning periods meaning more experience is a nonesense. You don't need 16 years of mostly 14 hour sleep deprived days to pick up the information you need. There needs to be a system similar to one used by pilots where basic accreditation as a pilot gives you the ability to fly a light aircraft in clear weather and then you progress through ratings for rough weather/low visibility, night flying, commercial flying, with ratings for each type of aircraft. Doctors need something similar. The license to treat a basic set of things, with accreditation/endorsement to treat increasingly serious and difficult diseases (and refer them on to a different doctor or work with an accredited doctor). This is pretty much what we have in terms of medical specialisation, but it needs to be applied to the basics. There also needs to be a strict limit of no more than 8 hours a shift except in a declared emergency. If that means we need more doctors that's what we should be getting with a quicker system in place for learning to treat minor conditions once they've been diagnosed.

Lastly, the medical profession seems to attract money hungry egomaniacs (particularly specialists). I've seen unforgivable behaviour from doctors such as prescribing upping the dosage of a medication that was causing seizures when this was clearly a contraindication. (In the end my fiancee went from having no grand mal seizures to two a day and if I hadn't diagnosed her instead of her specialist I suspect she'd be dead). Except in the most extreme circumstances doctors generally aren't held accountable because if you sue good luck finding someone to ever treat you again. Doctors who've been through all the hoops usually think of themselves as incredible fantastic people above the rest of us which quite frankly amazes me as they see things that cut others down in their prime every day. Basically most doctors need their ego deflated a little. Unfortunately the medical institution does nothing for this. It tends to be a highly political pecking order you have to work within to succeed where testing is a lot more subjective than it's made out to be (and therefore dissenters will quickly be punished severly).

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These posts express my own personal views, not those of my employer
Re:Common occurrence? by drsquare · 2006-07-19 21:05 · Score: 1

There is actually a lot that goes into becoming a competent physician. You may want your doctor to remove a mole now, but if that was all your doctor could do you might feel shortchanged when you needed someone to be able to manage your barely compensated congestive heart failure, set up your mechanical ventilator when you develop ARDS after a devastating car accident, or coax your premature infant through the first months of life.

Can someone provide a convincing argument why every single doctor needs to do every single thing? There's no reason at all why there can't be a doctor who's only qualified to do routine, non-essential things.

Face it, the AMA is a cartel.
Re:Common occurrence? by Cyberax · 2006-07-19 22:43 · Score: 1

1) know that it probably is a mole and not a melanoma
That is a part of dermatology.
2) know what medications to use for local anesthesia, their contraindications, and how much to use
That should be a part of basic education.
3) what the best resection method is to preserve a good cosmetic outcome
That is a part of dermatology.
4) how to suture it up without it popping open and increasing the risk of infection or a bad cosmetic outcome
This is a part of dermatology.
5) how to package the skin sample so that the pathologist can examine it effectively

6) read and understand the pathologist's report
Yes, that should be a part of basic training.
and 7) know what to do next if the mole actually isn't a mole but a melanoma.
That one is easy: "immediately transfer patient to the oncologist".

Certainly, dermatologist need no to be able to read EKG - cardiologist should do this after EKG is taken.

I still don't see why dermatologist must be able to perform heart surgery.
Re:Common occurrence? by Anonymous Coward · 2006-07-19 23:41 · Score: 0

I was going to reply to each individual point, but won't bother.
You're a fucking retard. You've obviously never even been to a hospital, let alone worked in the medical field.
The fact is, doctors need a good background in everything! You're as thick as fucking pigshit if you can't see that. You're an ugly fuck too.
A dermatologist CAN'T perform heart surgery! Fuck you're stupid. I can see why you didn't get into med school. You're an asshole anyway. Be nice, you bitter, boring cunt.
Re:Common occurrence? by Ihlosi · 2006-07-19 23:43 · Score: 1

I still don't see why dermatologist must be able to perform heart surgery.

Please, do the world a favor and have your cardiac bypass done by a dermatologist should you ever need one.
Re:Common occurrence? by Ihlosi · 2006-07-19 23:50 · Score: 1

There's no reason at all why there can't be a doctor who's only qualified to do routine, non-essential things.
Well ... these people exist, but aren't called doctors, but nurses, midwives, paramedics, assistants, etc ...
Re:Common occurrence? by Cyberax · 2006-07-20 00:14 · Score: 1

One of my parents is a doctor.

Yes, doctors need a good background on eveything. They don't need to be able to do everything.

And it doesn't take 16 years to get a fairly good background. Four years should be enough to learn the basic course and then three or four years of practice under supervision (i.e. apprenticeship) in a chosen specialization.

Of course, high-risk specialization doctors like surgeons or home doctors need more education and practice.
Re:Common occurrence? by Cyberax · 2006-07-20 00:16 · Score: 1

BTW, dermatologist doing a heart surgery was an exaggregation. You know, http://en.wikipedia.org/wiki/Hyperbole
Re:Common occurrence? by Anonymous Coward · 2006-07-20 00:57 · Score: 0

This post was the typical BS that the medical profession likes to feed the public. The author has well believed the propaganda fed him by the AMA.

Let's see: 4 years of college, 4 years of med school, 3 years of med residency --- I get 11 years of training, as opposed to 9 years for most other professionals (4 years, college, 5 years to PhD).

And most docs don't make "life or death decisions": they sit in their little offices and charge $300/hour to see them. And if they don't guess right, the first time when you have sleeping sickness, then you get to go back and pay them for another visit, so they can guess again. I don't think that happens with other mechanics: once they charge for fixing something, if they don't get it right, they fix it without charging: that's only fair and ethical.

You want real "life or death" decisions made under great pressure: talk to any small-unit infantry leader whose been in combat. There's the ultimate in critical thinking under pressure: when someone you've never met is trying to kill you for no other reason that you aren't wearing the same color clothes as they are, it sharpens the mind tremendously.

Patronizing bastard!
Re:Common occurrence? by lamp540 · 2006-07-20 01:40 · Score: 1

If doctors put so much effort and time into becoming doctors why can't they remember not to leave foreign objects inside patients? That people are having to resort to using RFID to prevent this doesn't say very much for the medical profession. Aren't doctors smart enough to use a checklist?
Re:Common occurrence? by amabbi · 2006-07-20 03:53 · Score: 1

Don't forget the AMA, which tells medical schools how many doctors they're allowed to graduate every year.
The AMA is an association of licensed physicians in the United States; it is more akin to a union and lobby group. It has no power to tell medical schools how to do anything (which lies with the American Association of Medical Colleges, the AAMC); it has no power to set the lengths of residencies (which lies with the licensing boards for each particular specialty). But keep on ranting; you're batting .000 here...
Re:Common occurrence? by amabbi · 2006-07-20 07:28 · Score: 1

Let's see: 4 years of college, 4 years of med school, 3 years of med residency --- I get 11 years of training, as opposed to 9 years for most other professionals (4 years, college, 5 years to PhD).
You're counting wrong. 5 years to PhD is an average (and I suspect that's on the low end; in my school the avg length to PhD in EE was 5 years after a 1-2 yr master's). Don't forget that most PhD fields require you to do 2-3 years of postdoctoral training. And there are 6-year combined BS/MD programs, if you're really sure of what you want to do before you start college.
As for the rest, if you want to go ahead thinking that the job of an auto mechanic with that of a physician/surgeon is the same... I don't think any amount of rational counterargument is going to convince you.
Re:Common occurrence? by nido · 2006-07-20 19:15 · Score: 1

I agree with the Anti-AMA/medical monopoly crowd.

If your general surgeon f's up your gastric bypass surgery because he was not adequately trained, and you get transferred to ICU and...

While it's true that lots of people are having the "surgery of the week" (gastric bypass), I wonder how our ancestors avoided morbid obesity without the availability of Gastric Bypass Surgery.

Not really. Gastric bypass is yet another example of the allopathic (a derogatory term coined by a homeopath) philosophy of treating the symptom while ignoring the cause, or perhaps, treating the symptom because they don't know what else to do. $20,000 (gastric bypass costs range from $17-24k) could get you a full treatment program with a competent hypnotist, several years worth of organic vegetables and natural foods, and a handy rainy-day fund to boot. But if insurance covers a $20,000 surgery, why should the fatty care what it costs?

My grandfather says the only thing he really remembers about Milton Erickson was how he was always "bitching" about having to learn anatomy, go to med school & residency, etc (Milton was an M.D./psychiatrist), when all he really wanted to do was hypnosis. Over the course of his career, Doctor Erickson "fixed" more people than the entire psychiatric establishment combined, and medical school was mostly irrelevant to the skills he had.

The emphasis on specialties causes a vast case of "missing the forest for the trees", which has led to medical costs rising out of control. Soon no one will be able to afford your services, so you might want to start learning about cost-effective options now, before you're unemployed. See, for example, Dr. Zieve's book Healthy Medicine: A Guide to the Emergence of Sensible, Comprehensive Care. I'm a big fan of osteopathic manipulation too, as another skill in the quiver that everyone should at least know is available.

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Learn the rules so you know how to break them properly.
www.teslabox.com
Re:Common occurrence? by andrewman327 · 2006-07-27 02:18 · Score: 1

I agree with what you are saying. However some of us who have training in healthcare view doctors as being aloof out of touch with those below them, but I know that you work damn hard on behalf of patients. I understand that it is a very tough job physically, mentally, and emotionally. After all, if it were easy then anybody could do it. I say that the "biological mechanic" idea stops at the First Responder or EMT-Basic level, as real doctors have to be able to deal with every possibility. Just because something might be easy most of the time does not mean that the minority might require sudden and complicated intervention by a skilled doctor.

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Information wants a fueled airplane waiting at the hangar and no one gets hurt.

Not about how big a problem it is by rsilvergun · 2006-07-19 06:39 · Score: 1

it's about lowering insurance premiums.

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Turn it around by Bruce+Perens · 2006-07-19 06:39 · Score: 2, Insightful

I'm more worried that they won't forget to put the RFID in the patient before they close the body.

Bruce

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Bruce Perens.

string works by Bootsy · 2006-07-19 06:40 · Score: 0

If its such a problem, why not a simple solution like string? Worked with my mittens when I was a young'n

Mod parent up by Valdrax · 2006-07-19 06:41 · Score: 1

I'm glad to see that I'm not the only who thought that surviving the autoclave would be a much bigger challenge.

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If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").

But... by FrontalLobe · 2006-07-19 06:42 · Score: 1

How is the RFID tag the government installed in the back of my neck while I was asleep going to affect this?

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-FL

Re:But... by nytes · 2006-07-19 10:04 · Score: 1

Congratulations, you have just been designated "sponge".

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-- I have monkeys in my pants.

The new trend: by gardyloo · 2006-07-19 06:45 · Score: 3, Funny

Warwalking. "Hm... Spidey-sense tingling. w00t! Free wireless!"

Pencil and Paper ... easier & cheaper by neonprimetime · 2006-07-19 06:47 · Score: 1

WTF? Why do they need a superduperwonderfulelectrogadget to solve this problem?
The easier & cheaper solution involves a pencil and a piece of paper.
Do you have the scalpel? Check. Do you have the bar of soap? Check.

Re:Pencil and Paper ... easier & cheaper by skiingyac · 2006-07-19 07:12 · Score: 1

I think the point is when there are 500 gauze pads soaked in blood, it is hard and time-consuming to peel them all apart and accurately count them.

It seems a simpler solution than RFID is just to embed an oddly-shaped piece of metal or something in everything they are going to use for the surgery, and then give you a good old X-ray, and look for bright, weird-shaped things on the X-ray. Of course, you should still attempt to manually count in addition...
Re:Pencil and Paper ... easier & cheaper by Dun+Malg · 2006-07-19 07:40 · Score: 2, Insightful

WTF? Why do they need a superduperwonderfulelectrogadget to solve this problem? The easier & cheaper solution involves a pencil and a piece of paper. Do you have the scalpel? Check. Do you have the bar of soap? Check.
Cripes, is this really that hard to understand? Currently, the way they do it is have people counting the instruments, through all sorts of redundant methods. Still, because it's humans doing the work, the system is subject to occasional human error. Your solution of "pencil & paper, duh" is more if the same: it's humans doing the work, so the system is subject to human error. RFID takes the error inducing element out. Pencil and paper does not.

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If a job's not worth doing, it's not worth doing right.
Re:Pencil and Paper ... easier & cheaper by badboy_tw2002 · 2006-07-19 08:06 · Score: 1

You don't think they do that already?

I'd be glad for them checking 3-4 times plus running the RFID scanner over me, if just for the peace of mind that I don't get a pair of scissors left in me.

Do you have a problem with triple redundancy on airplanes as well?

Since when are people so against extra safety procedures. I think you'd be great as the next director of the space shuttle mission control :)
Re:Pencil and Paper ... easier & cheaper by Millenniumman · 2006-07-19 08:20 · Score: 1

Is sponge #234 in the disposal?

Check!

Is #235?

Uh, I can't see it.

OH NO! (Cue moving red light and siren noises)

Oh, wait, it is under towel number 137.

Phew. Okay, let's see, we were on #258?

Uh huh. Check.

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Stupidity is like nuclear power, it can be used for good or evil. And you don't want to get any on you.
Re:Pencil and Paper ... easier & cheaper by winwar · 2006-07-20 02:44 · Score: 1

"RFID takes the error inducing element out. Pencil and paper does not."

Does it? I can see RFID's becoming common, staff relying on them instead of paper and pen, then leaving more things in people. Maybe there is a malfunction, the item didn't contain one, etc.

Aren't surgical tools made of metal? by dpbsmith · 2006-07-19 06:51 · Score: 1

If the chip is literally inside the tool, it seems to me that it would be hard to sense the chip.

If it's just glued very strongly onto the surface of the tool, then it could come off inside the patient.

And as for things like sponges... which proverbially (I'm saying "proverbially" because I have no idea whether it's true) are among the commonest things to leave inside, well, they're basically soft, aren't they, so you'd think it might not be that hard for the chip to come loose from the sponge.

I don't think I'd like to need to get cut open again just because nobody could tell for sure whether there was a tool or a just a chip. Of course they could X-ray, but if they could see everything clearly with the X-ray they wouldn't need the chip in the first place.

And unless there's an absolute guarantee that every instrument is chipped, well, the nurses need to know which instruments are chipped and which aren't, and keep an accurate count of the unchipped instruments...

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"How to Do Nothing," kids activities, back in print!

Gauze? by HockeyPuck · 2006-07-19 06:52 · Score: 1

SO does this mean that items like gauze/cottonballs etc... will now have RFIDs embedded in them?

Re:TFA by dpbsmith · 2006-07-19 06:54 · Score: 1

Ah. Well, the good news is that TFA says I'm right about sponges being common things to leave in the patient.

And the bad news is I've made it crystal clear that I didn't read TFA before I wrote my comment.

But the good news is I think my comment is reasonable, anyway.

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"How to Do Nothing," kids activities, back in print!

Hoping? by nate+nice · 2006-07-19 06:56 · Score: 1

So the scientists are "hoping" they shrink in size? Since when did scientists get all faith based on us? It's time to stop "hoping" and start doing, folks.

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"If you are a dreamer, a wisher, a liar, A hope-er, a pray-er, a magic bean buyer ..."

It's not too much of a stretch by beadfulthings · 2006-07-19 06:56 · Score: 1

A recent visit to a hospital nursery revealed that they're now equipping newborns with anti-theft devices. Sort of a cross between a LoJack and a department store anti-shoplifting tag, the device is secured around the baby's ankle and removed when parents and child leave for home. Presumably this would help in the event of an attempted abduction both by alerting people to the fact that somebody was leaving the floor with an unauthorized baby, and by allowing said baby to be tracked. It's not such a bad idea--too bad they are needed.

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"Here's what's happening. You're starting to drive like your Dad..." - Red Green

Re:It's not too much of a stretch by Anonymous Coward · 2006-07-19 07:14 · Score: 0

Actually, they use a "lojack" embedded in the cord clamp.
If baby leaves the wing (actually, just gets a little too close to the exit doors), ALL the doors from the wing and within the wing snap shut and alarms go off.
(It was really relaxing being there when the system was going through install and test.)

Plus baby gets a standard name band on both the wrist and ankle.
Then mommy and daddy get identical bands to the one the baby has.
Any exchange of the baby between the staff and parents includes a verification of the ID bands.
Re:It's not too much of a stretch by scottv67 · 2006-07-19 11:00 · Score: 1

A recent visit to a hospital nursery revealed that they're now equipping newborns with anti-theft devices. Sort of a cross between a LoJack and a department store anti-shoplifting tag, the device is secured around the baby's ankle and removed when parents and child leave for home. Presumably this would help in the event of an attempted abduction both by alerting people to the fact that somebody was leaving the floor with an unauthorized baby, and by allowing said baby to be tracked. It's not such a bad idea--too bad they are needed.

We have that system in the hospitals that I support. As a matter of fact, it went off earlier this week while I was walking through that area checking the signal on wireless access points in that wing. When that alarm goes off, EVERYONE stops what they are doing and no one is allowed to leave until the cause of the alarm is found. There is a big computer monitor that displays a floor plan of the wing with all exits marked. The sensor that was tripped is indicated on the display so the staff know exactly where to respond.

In the case that happened a few days ago while I was walking through that wing, a mom and dad were walking with their baby AND some contractors happened to be working on one of the exit doors in that area. Mom and Dad got too close to the open door and the system triggered.

Yes, it's sad that systems like this are needed but they work quite well.

Let's compare this to.... by TheDarkener · 2006-07-19 06:57 · Score: 3, Funny

A computer technician. I know, I know, they are very much different...but they're actually the same, too. ;)

Tech 1: Ok, just got done replacing the power supply in this bad boy, let's fire it up.

Tech 2: Hey, where's my screwdriver....

*ZOT*

Tech 1: Oh, wait a minute.... oh, ok here's the problem, I left this screwdriver lying on the motherboard and it fried the motherboard!

Tech 2: Shouldn't you have looked inside the case before you put the cover back on?

Tech 1: Maybe we should put RFID tags on our tools so I won't do this again...

Tech 2: .... *SLAP*

How about, stop smoking the sticky-icky right before you work on very important things (I.E. computers, human bodies)...

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It is pitch black. You are likely to be eaten by a grue.

Re:Let's compare this to.... by Zaplocked · 2006-07-19 07:49 · Score: 0

Right, because the interior of a human body is just like the interior of a computer...
Re:Let's compare this to.... by TheDarkener · 2006-07-19 07:57 · Score: 1

I acknowledged that the two scenarios were very different...

*douched*

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It is pitch black. You are likely to be eaten by a grue.

Size is the block? by dougman · 2006-07-19 07:01 · Score: 1

FTA, "The biggest current stumbling block is the chip's size".

These folks should talk to HP. According to /., they are making them the size of a grain of rice or was it a tomato seed?

I think this is another great example of how the technology can be used for good.

Re:Size is the block? by inKubus · 2006-07-19 09:11 · Score: 1

There's also the "Digital Angel", which actually has FDA approval for implanting into humans.

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Cool! Amazing Toys.
Re:Size is the block? by inKubus · 2006-07-19 09:13 · Score: 1

Oh, it's called "VeriChip" now.

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Cool! Amazing Toys.

I was wondering... by avatarz · 2006-07-19 07:02 · Score: 0, Redundant

I was wondering what would happen if the RFID tag after all the steam and hot temperatures of the sterilization process....

It really does happen by Aqua_boy17 · 2006-07-19 07:03 · Score: 1

Several years ago, there was one case at a local hospital that made the newspapers. A woman had come in for adbominal surgery about 6 or 8 years earlier and was now complaining of pretty severe stomach pains. X-Ray examination quickly revealed that there were not one, but two hemostats that had been left inside her after her surgery.

We were never able to confirm whether her admitting diagnosis had been "A bad case of Stomach Clamps".

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What if the Hokey Pokey really is what it's all about?

Ok... by Jeff+Molby · 2006-07-19 07:05 · Score: 1

So the outlining idea wouldn't work, but they can still count the stupid things.

Why not a metal detector? by AnotherBlackHat · 2006-07-19 07:05 · Score: 1

Do they really need a precise count?
The number of things left in the patient should be zero.
I'd think a normal metal detector could detect most tools without modification,
and it wouldn't be that hard to add a bit of steel to the sponges.

The same technology they should be using at the MRI machine.

-- Should you believe authority without question?

Re:Why not a metal detector? by TheTwoBest · 2006-07-19 07:27 · Score: 1

Yes they need a precise count.

A metal detector won't work. Think about how sensitive you have to make it in order to detect a small piece of metal. Now lets think of all the other pieces of metal that are around the OR and on the table. Not to mention that you do counts are various stages (you really don't want to discover that you left something behind after you close...

Anyway, most surgical instruments do have metal in them, but not so they can use a metal detector, but rather so you can xray the pt and see whats there. However, since you don't want to expose the pt to unnecessary radiation (and the cost), you only do this if the count comes up short.
Re:Why not a metal detector? by karandago · 2006-07-19 08:50 · Score: 1

A bit tough when someone just got a shiny new metal knee joint.

I'd be more worried about an over reliance on RFID tags causing lazyness.

Argh by hurfy · 2006-07-19 07:08 · Score: 1

Is this the new way to force us to read the article...make the headline/summary inaccurate or misleading??

I guess sponge is a tool in the broadest sense, but they really talk about sponges. I was thinking instruments. Trying to guess how the hospital could imbed anything into stainless steel, hehe.

Makes more sense as the sponges are the item that needs it most. Needles and blades usually get put on a magnetic card with numbered slots. If you opened 6 there should be 6 used on card/box before you toss it ;) Some sponges are really hard to count BEFORE use, afterwards its even worse. Plus they hide easy.

Of course these cost several times as much i imagine, like surgery needs another expense :(

Re:Argh by andrewman327 · 2006-07-26 06:13 · Score: 1

I did not mean to mislead /.ers in my writeup. Apologies.

I do not think that these will add to the incredible cost of surgery any more than RFID tracking will add to the cost of vegtables or anything else with which it shall be paired.

--
Information wants a fueled airplane waiting at the hangar and no one gets hurt.

Re:My Dog - not in patient... by fahrbot-bot · 2006-07-19 07:12 · Score: 2, Funny

My dog has a very small RFID...

This will definitely help keep your dog from being left inside a patient...
Doctor: Dog?
Nurse: Check.

--
It must have been something you assimilated. . . .

use once stuff... by geoff+lane · 2006-07-19 07:18 · Score: 1

...should be biodegradable.

An even better idea! by takeya · 2006-07-19 07:23 · Score: 1

Just keep a checklist, a real, live checklist on paper, and check off every tool as you locate it before closing. That way, no chips will malfunction and not be detected, resulting in an instrument left in the body.

Re:An even better idea! by Wudbaer · 2006-07-19 09:22 · Score: 2, Informative

Which is exacly how it is (or should be) done, and yes, I am a MD by training. The OR nurse assisting the docs during the operation opens a certain amount of surgical instrument etc. kits with a clearly defined number of items in it. It is one of her responsibilities to keep track of the number of instruments she gives to the doctors as well as the number she is getting back and ones that get "lost" outside the patient (dropped to the floor, given to a third party outside the operating team, e.g. to pass tissue samples or excised organs, tumor parts etc.). The same applies for gauze pads, surgical cloth etc. Gauze particles and cloth also have either metallic tags or markings that show up on X-rays on them to be able to locate them either after the fact or, in difficult cases where you know something is missing but can't find it, before clothing the patient using a portable c-beam x-ray machine.

Nevertheless both the nurses and the docs are only human and work often inhuman working hours under extreme pressure, so in spite of all those measure it still can happen that surgical items remain inside the patient.

A zero-sum gain by aschoeff · 2006-07-19 07:29 · Score: 1

If this technology actually comes to market, it will only result in a temporary drop in these cases. Doctors will start to rely on a non-visual frequency sweep of the patient, which will make the baseline event rate drop to the failure rate of the RFID tags combined with the unavoidable operator error (mostly from laziness) that creeps in with any technique or technology.

I see this more as a way for medical equipment companies to control recycling of instruments so as to increase sales by fending off competition from refurbishers.

Then again, if we could just sweep a pile of medical waste that washes to shore for RFIDs and trace it to whoever is responsible for dumping it, that would be a major plus. Even this would be a temporary benefit, as the illegal dumpers will find some easy way of frying all the RFID tags before doing so.

To sum it up, this has a lot of upside for manufacturers, not much for doctors or the patients.

Um, and embedding these tags in metal tools has its complications, right? Fermi cages, anyone?

Cadaver RFID by Anonymous Coward · 2006-07-19 07:30 · Score: 0

It has been suggested that RFID chips could be placed in cadavers to try to discourage the blackmarket in body parts - maybe you could just leave them in (especially if the operation failed).

Synergic Public Utility Cornucopia by Anonymous Coward · 2006-07-19 07:32 · Score: 0

"Our airport security scanners have detected somethig strange.

Please come with us into this little windowless room where no-one can see or hear anything."

- Well. At least, once they use Tasers, the evidence is toast.

Say, what was that movie again ? The Fortress ?
'Internal Id' ?

At the airport..... by MindPrison · 2006-07-19 07:38 · Score: 1

Inspector: Hmmm...that's odd, the scanner says scapel

Me: How can it be so precise?
Inspector: Are you carrying a scapel?

Me: No - of course not

Inspector: We have to strip search you - you know...

Me: Okay...(follows them into the white polstered room)

Inspector: Now - strip!

Me: (Doing my strip routine)

Inspector: Man - you're ugly!

Me: What was that?

Inspector: Erhm...I said....man You're lucky! You have no scalpel on you!

Me: Oh, fine...can I go now?
Inspector: No...my RFID reader says that you are carrying a Scalpel on you!

Me: I had surgery last week....

Inspector: Oh, good ol'doc must have forgotten it inside your belly then, eh?

(Inspector reads me all over with his fancy pants RFID scanner)

Inspector: Yes - you do. It's Pyrex-Model 12678236, made in taiwan too. Those cheap bastards.

Me: Really? You can see the brand too?

Inspector: Yeah, these things are really advanced.

Me: Cool, now let me do you....

Inspector: Beg your pardon?

Me: No...I just want to read you....gimme the scanner...

Inspector: It's against policy, we're not allowed to hand over our RFID readers to the public.

Me: Who cares? Scan yourself.

(The Inspector scans himself)

Inspector: Thats funny, it says - "Born to serve - serial #12453123"

Me: Heh..that's you allright - born to serve!

Inspector: What the hell?

Me: They probably RFID tagged you.

*Edit* Stupid boring story ends here before we get way off....You get the idea.

--
What this world is coming to - is for you and me to decide.

Carry your own Medical charts by Tandoori+Haggis · 2006-07-19 07:39 · Score: 1

Eliminate the risk of your medical charts getting lost or swapped with other patients. Carry your medical information in an RFID implant.

Name: Fang
Colour: Black, White, Tan
Weight: 27 Ibs 3 Oz
Height: 23"
Pulse Rate: 118
Temperature: 102 deg F
Condition: Intestinal worms, bad breath.
Handling notes: May bite if stared at.

--
My hyperlinks aren't worth the paper they're printed on.

Rushed circumstance by phorm · 2006-07-19 07:43 · Score: 1

Except in some instances I'm guessing that things are a bit rushed, in which case you'll be calling in people, equipment, etc. Generally mechanic-work has all the tools readily available, and in any event they're generally counting that the number of screws that came out also go back in. If the doc forgets to put something back that should have been, it's a bigger problem that RFID isn't going to fix.

They do by TheTwoBest · 2006-07-19 07:46 · Score: 1

They already do this.

Just to clear up a bunch of misconceptions, there are already systems in place to prevent this kind of problem, but its not foolproof.

Everything that gets used during an operation is counted (all the boxes say what's in them and how many). Each sponge, scalpel blade, etc. usually does have its own little outlined slot that it gets placed back into at the end of an operation. Towards the end of the operation (and multiple times for more complicated surgery) the scrub nurse will lead a count of all equipment. In the ideal situation, everything is accounted for and all is well.

This simple process can be complicated by the fact that you often do counts before you close the patient (no sense in closing up, and then figuring out you left something behind). However, at this point you still have to close the patient (and those needles used to stitch em up also need to be counted, along with sponges used for closing, etc). The point is, there is a lot going on. Regardless, at the end of the operation, the final count should have everything accounted for.

However, what do you do when the count comes up short? Obvious answer is to not close the patient and find the missing instrument. Still, we had a case yesterday where we came up short one needle. We spent two hours looking for it, and recounting everything while we waited for a fluoroscope (they were tied up). We finally x-rayed the pt, and determined that the needle wasn't inside and we could wrap it up. The conclusion: we never found the needle. Now an OR is pretty small, so it was in there somewhere, we just couldn't find it. How often have you lost something and been unable to find it, especially a tiny little thing like a needle? In our case we were lucky that it would have easily shown up on x-ray so we could be pretty certain it wasn't in the patient and no longer a risk, but this is not always the case.

So in this regard, lets stop bashing some of the docs for being lazy/cheap/out to make money etc. No one wants to leave something behind (especially a sponge). Its not good for the doc, the patient, nor the hospital. Its also not something you can really cover up. First off, you always find out, sponges inside of people -> infection and problems. So the family will know, and the docs insurance will settle with them (and so will the hospital because its bad PR). End result, no one is happy.

If this technology worked, the other systems would stay in place, this would just be an additional check, another safeguard. It would also allow for greater reassurance that nothing was in the patient when a count came up short. Anyway, if they can work the kinks out, it would be a major improvement, and one that should be welcomed.

Re:They do by Ana10g · 2006-07-19 09:30 · Score: 1

Not to be picky here, because I wholeheartedly agree with your statements, but, in your example there, I assume you are speaking of the needle, not the whole syringe, right? In that case, would it even be possible to chip the needle? I suppose that, were it to have a threaded tip (do they make needles like that anymore?), you could put it there, point is, it will lead to customized tags, which will be more expensive to manufacture. Anyway, the idea is great, and it's in the right place. Hopefully, these sorts of things can be worked out.

--
just an analog boy living in a digital age.
Re:They do by TheTwoBest · 2006-07-19 09:42 · Score: 1

I was actually talking about a needle for suturing (putting in stitches). They come in various size and shapes, but they are like small sewing needles with an eyelet, or a similar shape but with the "thread" attached to the end (its kind of a small crimp).

While the technology is not ready for use in something as small as a needle, hopefully its not too far off.

666 by KingKiki217 · 2006-07-19 07:47 · Score: 1

My dad did a research project on RFID, and this site came up: http://www.tldm.org/news4/MarkoftheBeast.htm Fundamentalist Christians love to look crazy.

Hi, everybody! by andrewd18 · 2006-07-19 07:53 · Score: 1

As long as you don't go to Dr. Nick Riviera, you shouldn't have any problems finding tools in your stomach post-surgery.

is it too much to ask? by seven+of+five · 2006-07-19 08:03 · Score: 1

How 'bout the surgeons slow down to improve patient safety, and check to make sure they didn't leave a coffee/wristwatch/golf club/hemostat in the patient?

Re:is it too much to ask? by geekoid · 2006-07-19 08:46 · Score: 1

so, which person in triage gets to die?

It's not like they got 10 tools they use. There could be hundreds. What happens if a situation need attention NOW or the patient dies?
People make mistakes, espcially after working 12 hours in surgery.

What if a tool was accidently disposed of? Or a nurse left the operating room with a tool by mistake?

--
The Kruger Dunning explains most post on /. http://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect
Re:is it too much to ask? by Anonymous Coward · 2006-07-19 08:49 · Score: 0

Because you aren't willing to pay for them to do that. Putting chips on everything won't work, but at least it'll be cheaper.

This is bull... by LOADLETTER · 2006-07-19 08:07 · Score: 0

The receiver is in the toolbox (surgical, jet-plane mechanic, NASA employee etc.) Missing tools raises the flag.

11 in 11 out by Brix+Braxton · 2006-07-19 08:08 · Score: 1

Seems that simple doesn't it? You bring 11 tools to the table, you make sure you have 11 when you are done. I can't picture a doctor opening someone up and saying "hmm... you know what tool would work great on that bladder? Give me my X024 - it's in the top drawer next to my desk...".

My wife has gone under the knife a couple of times and that's what seemed to be the common theme - count before, count after - a human CRC of sorts.

--
www.wildpad.com

Doctor Evil by sensei85 · 2006-07-19 08:40 · Score: 1

I didn't spend 6 years in evil medical school to be called "Mr.", thank you very much.

now, has anyone seen my "laser" tweezers?

Here's a really good idea by Mr.+Freeman · 2006-07-19 08:51 · Score: 1

How about we assume that the surgeon we're paying however many thousand dollars per hour to operate on us, that graduated from a medical school can actually make sure he doesn't loose a scalpel inside of us.

If you can trust the surgeon to not leave something inside of you, then how the hell do you think he would be competent enough to operate on you?

--
-1 disagree is not a modifier for a reason. -1 troll, flaimbait, redundant, overrated are NOT acceptable substitutes.

Re:Here's a really good idea by sensei85 · 2006-07-19 09:01 · Score: 1

We certainly don't want a surgeon to loose a scalpel inside of us. Just imagine a scalpel wandering around, wreaking havoc wherever it pleases.

Also, people need to RTFA, as well as the previous comments. It's like you read a headline and go right to the "reply" button. For shame, /., for shame.

That's not the problem by Anonymous Coward · 2006-07-19 08:54 · Score: 0

Tools really aren't the biggest problem. Just put them through an X-ray when you can't find your watch and it'll light up like the forth of July.
The real problem are the pads, tampons and sponges that are used... It's easy to miss a blood soaked tampon tucked away behind a liver after a bloody abdominal surgery. Are they planning on putting tags on those things as well? That'll be some expensive piece of cloth.

I can imagine this converation... by Anonymous Coward · 2006-07-19 09:12 · Score: 0

Doctor (after closing up the patient): All done. Stand-by for RFID-sweep.
Nurse (looks left and right): Now where did I put the damn thing...

My perspective... by BigDukeSix · 2006-07-19 09:15 · Score: 1

... as a surgeon.

Surgical instruments are kept in prepackaged sets for anticipated needs. A "major abdominal" set has different instruments than a "major vascular" set or a "GYN" set. The situation arises in emergencies, however, where you need an instrument from another set than the one initially opened, and if the surgeon has achieved that sublime state known as "audible bleeding", sure as hell no one stops to count out the set. Repeat enough times and it happens, and it's a big deal when it does.

It's pretty easy to make sure the sponge, needle, and instrument "counts are correct" during routine, elective surgery, and that ritual phrase is spoken to me by every circulating nurse I work with to let me know that it's okay to close. I don't see anything wrong with this invention, except that everything allowed on the field is already radioopaque (that's why surgical sponges have that blue thread sewn in, or the blue tag hanging off). If there's any question at all, you get an x-ray.

Surgery is not car work by gnuman99 · 2006-07-19 09:26 · Score: 1

With computers it is very easy. You do NOT need to count anything. Just shake the case a bit and any lose screws will be heard nice and loud. Or they fall out :) Plus you have 2 different types of threads and a handful types of screwes. Not quite the same.

With surgery. Let's see. How will you know you have 2 or 3 sponges in a patient or a clamp somewhere when you also have 30 other things in there? Think about the "mess" of wires in a computer case then try to image crap in one's body - they don't really compare. You do not have anything "color coded" or otherwise. And each one is different from another. Also, it is easier to lose stuff in fat people for example.

Currently there people looking after tools used (not the doctor - the doctor's job is keeping the patient alive!). But when you have 5 seconds to verify everything is back, you sometimes miss stuff. And no, you cannot sit there having your patient open for 10-30 minutes while you count 100 tools, sponges, etc.. you used and verify with the clipboard like a car mechanic or yourself with your computer.

RFID solution would help and this is probably one of the best places for RFID as far as I know.

Nice idea, but missing the bigger errors by rc5-ray · 2006-07-19 09:38 · Score: 1

I notice that TFA is actually about sponges. As many previous posts have mentioned, these are much harder to detect when they've been left in surgery. Here's my perspective:

I'm a physician and the most common major surgeries I perform are C-Sections (I've done two in the last 36 hours, BTW). As already noted, the nurses do sponge, needle, and blade counts before the surgery, and they count more than once, and two nurses participate. Each surgery packet has a standard number of certain instruments, and these counts are also verified.

During the surgery, the surgeons obviously use up a fair number of sponges. As the sponges get bloody, the scrub nurse takes them from the surgeon and hands him/her a new one. The bloody sponges are placed in groups (usually of five) on a sticky mat on the floor (like flypaper), and the circulating nurse keeps a running total. As the surgery nears conclusion (for example, I've finished sewing up the uterus, but not closed the abdomen), the nurses start a sponge, needle, and blade count. If it's not correct, they count again, and again. Unless the surgery is at a critical stage, the surgeon(s) will stop and look everywhere in the surgical area, in the folds of the drapes, etc., until the missing item is found. In the case of sponges, they're usually hidden in a drape fold, or two bloody sponges are stuck together and counted as one. If a blade or needle can't be found, the portable X-Ray machine is brought in and the patient is X-rayed to make sure nothing is in the surgical field.

Only the most callous, stupid, and arrogant surgeon would knowingly say, "Oh, I'm sure you miscounted all six times. Lets close up anyway."

These mistakes are bad and avoidable, but they're certainly not the most common. It makes a big headline and lawyers start to salivate like Pavlov's dog when they hear them. But, wrong patient/wrong surgery/wrong side/sponge-left-inside events are much less common than other errors. For example, if we (the medical profession) could eliminate medication errors (wrong dose, wrong drug, wrong time, wrong patient, allergies), we would drastically reduce the number of errors and patient injuries and deaths.

This is an interesting technology, but it's going to cost an inordinate amount of money. I think it would be better spent trying to reduce or eliminate the most common errors first.

Just my 2 cents. Of course, I could be wrong (with apologies to Dennis Miller).

the non-ISO compliant Operating Room by kris_lang · 2006-07-19 09:39 · Score: 3, Informative

Hey

Let me give you a quick summary of procedure in an operating room, as regards instruments and instrument counts:

Every surgeon has a card (usually, literally a 3"x5" index card) with preferences and requirements for each particular operation they perform: for an appendectomy they may need a Saxony brand defrobulator and a #10 blade as the specialized items and they like to close the bowel with 2-0 (aka 00) chromic (made from catgut) and they like to close the skin with 3-0 poly and 6-0 purebread (usually used in cataract / ophthalmic procedures, but hey Underdog spoke out to me.) There might be three each of any particular scalpel blade they need and howsoever much of those stitches threaded on the appropriate types of needles: curved, straight, cutting, non-cutting, etc. There will also be the appropriate number of hemostats, deblooduclips, etc, that are necessary for the procedure. For a different procedure, say a vasectomy,... okay, let's say cranial burr hole or craniotomy for decompression of subdural for all the guys wincing out there, they may want a hand-twist drill, plastic clips for holding the scalp edges, good thick chromic for the fascial closure, etc., so a different set of objects.

There will be a minimum of two nurses assisting with the procedure, a scrub nurse (scrubbed in to the operation, hence the name) and a circulating nurse. The circulator will make sure that the tray with all of the equipment is already there before the operation starts. Even before the surgeon scrubs in, the scrub nurse will also go over the instruments and objects and de a pre-op count: making sure that there is enough of every item and making a note of the number of objects, including sponges which are actually small pieces of cloth uses to sponge up that red stuff that leaks out humans when they're cut. These cloths usually have a radio-opaque fiber sewn into them so that when they're accidentally left in the human body, something is easily apparent on X-ray or C-T; cotton is not so opaque to x-radiation.

The nurses know that there are int counts[i] of char* objects[i] for each of the different objects. The preop counts array is usually written on the form the circ nurse fills out. Then all of the really good fun stuff
happens, and as it is almost all done and the surgeon is getting ready to close, the scrub nurse starts a pre-close count: counts that the number of needles handed back by the surgeon plus the number of unused needles adds up to the number that was in the pre-op count (for each variety of pre-threaded needle). They also check that the number of clean unused sponges (whether 1"x1", 2"x2", 0.5"x0.5", etc) added to the number of blooded sponges handed back by the surgeon off of the surgical field also add up to the number expected. All of the other instruments: retractors, hemostats, bolt-cutters (used to cut the titanium bars in the fun ortho cases), machetes (used in amputations...), are also counted to make sure none are missing. (sometimes, even retractors fall into the morbidly obese and are missed.)

If the pre-op count is not correct, there is a frenzy as the doc looks inside the patient (or, if the closing is happening real fast, the doc says find it find it and the nurses run around checking the little bits on the floor and mopping up with surgical cloths to see if a needle fell onto the floor or onto the surgeons' or nurses' gowns or even if the needle is stuck onto the bottom of the little blue booties the OR personnel are using to cover their hospital footwear.)

If the count is correct, then the closing is done, and then the scrub nurse does ANOTHER final post-op count and rewrites it all down to make sure nothing was left behind.

Amazingly, even in cases where stuff was left behind, the written records usually show that the count was correct: someone takes a shortcut and writes a copy of the list and it often isn't until the patient has an infection or a recurrent problems days, weeks, months, years down the r

Re:the non-ISO compliant Operating Room by oopsdude · 2006-07-20 01:50 · Score: 1

The nurses know that there are int counts[i] of char* objects[i] for each of the different objects.

I think you mean char** objects[i]. Lord knows we don't want a buffer overflow during a vasectomy.

Common occurrence? Rant-a-thon. by Anonymous Coward · 2006-07-19 10:23 · Score: 0

Amen! Someone is the voice of reason when everyone else wants to turn this into a rant-a-thon (with the inaccuracies that go with that). Bring your buddies. Bring your pals, and just maybe we can get the old slashdot back before it's too late.

Re:Here's a better suggestion: by scottv67 · 2006-07-19 10:42 · Score: 1

Gotta feed the troll:

How about doing your FUCKING JOB PROPERLY instead of abusing technology to make up for your stupidity?

The doctors who are performing the surgery as well as the highly skilled nurses and other O.R. staff *ARE* doing their jobs properly. They are putting your body back together at 2:30am after the fire department used the Jaws of Life to cut-open your car (which you wrapped around a light pole on the way home from the bar) and extricate your close-to-dead ass from the wreckage.

How about showing a little gratitude that these profesionals are on-call and ready to save your life because you decided to have a few too many Long Island Iced Teas and then drive home? These people are *very* good at what they do. They are highly trained and have well-documented policies and procedures to follow.

Intead of spouting-off about the people who may save your life someday, put on some scrubs (or a "bunnysuit") and watch a surgery in person. The amount of tools and materials used in an operation as well as the coordination between the various specialists is amazing.

If someone can develop a piece of technology that will make a rare "event" in the OR even more rare, why not use it?

Even if you don't appreciate the work that these professionals (some of whom have posted in this discussion today) do, they will still save your life anyway.

But what if..... by ChestyLaRueGal · 2006-07-19 10:54 · Score: 2, Informative

say a drill bit breaks off inside? My grandmother has several pieces of drillbit stuck in her wrist from sugeries. Fancy RFID technology isn't helpful there.

Re:My Dog - not in patient... by Anonymous Coward · 2006-07-19 10:57 · Score: 0

ROTFL, I haven't laughed this much in a while now. Too funny!

if they forget by martinflack · 2006-07-19 11:03 · Score: 1

Of course, if they forgot to scan you, then you're going to trip EVERY SINGLE store inventory control alarm.

Try explaining to the Walmart greeter that you have a chip embedded in you accidentally that is setting off that forbidding voice.

Multiple failures... by Vellmont · 2006-07-19 11:04 · Score: 1

The article says that surgical tools are left in in about 1 in 10,000 operations, so I'd say they're already taught to count the number of tools used before and after. Obviously this method works very well, but isn't perfect, and probbably can't be made perfect by just telling people to "Just count the damn instruments".

The point is that in something as important as a surgery you want multiple things to fail before you have a bad result. This approach is often referred to as "Defense in Depth", and was originally a military strategy. Anytime lives are at stake you should strive for redundancy in your system. In this case that redundancy is using RFID to make sure the count wasn't off.

--
AccountKiller

Re:Multiple failures... by Khaed · 2006-07-19 11:33 · Score: 1

I guess I came off harsher than intended because of the way I feel someone as educated as surgical staff, and well paid, should do well. 1 in 10,000? Well, that's quite good, and I shouldn't have sounded so harsh about it.

I wasn't suggesting we not have redundant messages. Hence the title starting with "Okay."

Personally, if given the choice between RFID and not during a surgery on me? I'd go RFID.

Candy RFIDs? by Slur · 2006-07-19 11:06 · Score: 2, Funny

And of course, Junior Mints should come with RFIDs just to be safe.

--
-- thinkyhead software and media

Senile Bacon Number by LunaticTippy · 2006-07-19 11:28 · Score: 1

The biggest problem for me is my Mother. She emails 100 people all the time, forwards things around like crazy, and never listens to me about chain letters, obvious urban legends, or the fact that I don't care about aunt whoever's surgery.

Of those 100 people, about half of them are like my mother. And so on, and so on. It all goes to a special directory, anything with my mother's address in it, but I do have to read some of them to maintain the peace.

Anyway, I know things about complete strangers I never wanted to know. Technically I could trace how I "know" them, I suppose.

The most ironic part is I gave her the computer as a present. So I wouldn't have to talk to her on the phone so much.

--
Man, you really need that seminar!

Are doctors crazy or careless ? by dindi · 2006-07-19 12:35 · Score: 1

Or is it the assistance personnel ? WTF seriously ?

I am sorry, but i have never left a screwdiver in any operated computer ever in my life ... no extra screws, no extra trash, and definetely no tools...

and i those were just computers (some cost 5 digits though) , not humans .....
and i was sysadmining in my messy college years - going to school straight form a party, then to work and after 2 days no sleep .... I mean messed up, but still no tools left inside machines, or even the server room ....

oh wait ... metallic objects hide so well inbetween the tissue ... or dunno ....

What about... by zobier · 2006-07-19 15:11 · Score: 1

What about when doctors start leaving RFID chips behind on purpose?

--
Me lost me cookie at the disco.

UnCommon occurrence?-Good posts. by Anonymous Coward · 2006-07-19 17:19 · Score: 0

Another good post. Keep up the good work. This forum needs it badly. BTW Who needs more training? A medical doctor, or a veterinarian?

Re:UnCommon occurrence?-Good posts. by Mr.+Burrito · 2006-07-19 19:01 · Score: 1

That's a good question. I love animals and I think veterinarians have a particularly tough job. I've got only one species to think about!

Would not it be cheaper... by mi · 2006-07-19 17:54 · Score: 1

... if people just stopped getting sick?

Why, every time an improvement in the area of weapons and defense is discussed, someone makes an "insightful" comment on how we should be "making less enemies" instead of fighting them.

Flaimbait my behind — the sick could've used the gym more often and watched their diets better too. Do I get an "insightful" moderation now? I dare you...

--
In Soviet Washington the swamp drains you.

Not a good solution. by master_p · 2006-07-19 19:18 · Score: 1

RFID chips are very large due to their antenna; the actual chips are very small. So it is highly unlikely they will find a solution to the problem of size.

Secondly, surgery tools are supposed to be sterilized. If an RFID chip is sterilized, it will be most probably destroyed. If, on the other hand, RFID chips are put on tools after they are unwrapped/sterilized, then the advantage of sterilization would be lost: RFID chips would have all sorts of bacteria on them.

Thirdly, radiation from RFID readers is also a problem both for the patient and the doctors/nurses.

There is an easy solution to the problem: a checklist. Every tool used is written down, and after the surgery the list is scanned to see if all the tools are in their position.

BEEP BEEP by conn3x · 2006-07-19 22:15 · Score: 1

I think instead of a wand they should implement a wal-mart like inventory control system on the hospitals entrance. It would save time, and there's something about a voice going "BEEP BEEP Please report back to surgery. You are attempting to remove an unauthorized device from the premises" to really take the edge off of your recent surgery.

Re:BEEP BEEP by andrewman327 · 2006-07-25 07:27 · Score: 1

But then they couldn't steal surgical supplies! My blanket of surgical guaze would forever remain incomplete.

--
Information wants a fueled airplane waiting at the hangar and no one gets hurt.

Re: the article above by Anonymous Coward · 2006-07-20 00:41 · Score: 0

"i wish i had mod points" as the phrase goes... for you and your parent poster.

Actually did you see what Kris wrote above about the "ISO 9000 noncompliant Operating room" in this article: http://slashdot.org/comments.pl?sid=191618&cid=157 46454 ? I agree with the both of you: it's crazy to expect high-tech to get into the middle of the flow of something like this, particularly when actually following the correct procedures should get you exactly what is needed: that there are no unaccounted for items at the end of an operation. MGH's OR of the future is kindof like the Detroit "car of the future" or the jetsonian future view of Popular Science mocked by the King of Queens making a delivery with a jetpack: "package for Mr. Spacely..."

Ever have the LENS fall off a surgical microscope onto the operative field? I just about broke the sterility of the field cracking up at the comment "Well I'm sure that's not in the count..." !
Oh, zeiss! i mean scheiss.

The point is.... by Mr.+Burrito · 2006-07-20 04:55 · Score: 1

The point is that there are a hundred things you do and a thousand things you think about every day as a physician, and sometimes even seemingly simple things (like removing a mole) have multiple steps to them. Believe it or not, there are only so many things that you can learn to do in the 2 clinical years most medical schools give you. A lot of those things maybe you only do once and need a lot more practice.

The years of training include undergraduate, medical school, and residency. There is an emotional maturity component, too, that for most people doesn't kick in until after college anyway.

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Surgical Tools to Include RFID

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